Provider Demographics
NPI:1336467067
Name:DIAZ, MARIA TERESA (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:TERESA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11785 NORTHFALL LN
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-7971
Mailing Address - Country:US
Mailing Address - Phone:678-393-0012
Mailing Address - Fax:678-393-5158
Practice Address - Street 1:11785 NORTHFALL LN STE 505
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-7961
Practice Address - Country:US
Practice Address - Phone:678-393-0012
Practice Address - Fax:678-393-5158
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN199729363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner