Provider Demographics
NPI:1821724279
Name:VIRGADAULA, LINDSEY LILY (FNP-C)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:LILY
Last Name:VIRGADAULA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 W ELLIOT RD STE 115
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-5301
Mailing Address - Country:US
Mailing Address - Phone:480-545-0000
Mailing Address - Fax:
Practice Address - Street 1:725 W ELLIOT RD STE 115
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-5301
Practice Address - Country:US
Practice Address - Phone:480-545-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ306147363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily