Provider Demographics
NPI:1417625096
Name:GARCIA NIEVES, DIANA PATRICIA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:PATRICIA
Last Name:GARCIA NIEVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1683 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-8482
Mailing Address - Country:US
Mailing Address - Phone:732-456-2930
Mailing Address - Fax:
Practice Address - Street 1:701 COOPER RD STE 16
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-8007
Practice Address - Country:US
Practice Address - Phone:856-429-2224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01181500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily