Provider Demographics
NPI:1326334848
Name:DIAZ, MARIA LINDA (PNP)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:LINDA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-1610
Mailing Address - Country:US
Mailing Address - Phone:718-764-2410
Mailing Address - Fax:917-521-0983
Practice Address - Street 1:105 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-1610
Practice Address - Country:US
Practice Address - Phone:718-764-2410
Practice Address - Fax:917-521-0983
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY382149363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00245423Medicaid