Healthcare Provider Details

I. General information

NPI: 1508780644
Provider Name (Legal Business Name): LAUREN JATZLAU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MEDICAL PKWY
CEDAR PARK TX
78613-7464
US

IV. Provider business mailing address

1077 COUNTY ROAD 310
LEXINGTON TX
78947-5136
US

V. Phone/Fax

Practice location:
  • Phone: 512-528-7000
  • Fax:
Mailing address:
  • Phone: 512-281-6257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number1039035
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: