Provider Demographics
NPI:1477842920
Name:DIAZ, TARA ROSE (RN)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:ROSE
Last Name:DIAZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SHARON WAY
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-4203
Mailing Address - Country:US
Mailing Address - Phone:914-423-5429
Mailing Address - Fax:
Practice Address - Street 1:15 SHARON WAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-4203
Practice Address - Country:US
Practice Address - Phone:914-423-5429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY599062-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health