Provider Demographics
NPI:1649789892
Name:GUAJARDO, HAZEL RAE (FNP)
Entity type:Individual
Prefix:MS
First Name:HAZEL
Middle Name:RAE
Last Name:GUAJARDO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:HAZEL
Other - Middle Name:RAE
Other - Last Name:DALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5929 BALCONES DR STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4280
Mailing Address - Country:US
Mailing Address - Phone:512-550-1800
Mailing Address - Fax:361-884-2243
Practice Address - Street 1:5826 ESPLANADE DR # 304A
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4173
Practice Address - Country:US
Practice Address - Phone:361-998-9934
Practice Address - Fax:855-828-0878
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF09170837363LF0000X
TXAP135818363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily