Provider Demographics
NPI:1295370138
Name:DIAZ, ERICA ELGUEA (FNP)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:ELGUEA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 WALLER ST
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-6352
Mailing Address - Country:US
Mailing Address - Phone:469-233-4990
Mailing Address - Fax:
Practice Address - Street 1:106 PLAZA DR
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-3981
Practice Address - Country:US
Practice Address - Phone:972-505-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144035363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily