Provider Demographics
NPI:1508194325
Name:DIAZ, SCARLETT R (FNP-C)
Entity Type:Individual
Prefix:
First Name:SCARLETT
Middle Name:R
Last Name:DIAZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 CROCKETT DR
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-5900
Mailing Address - Country:US
Mailing Address - Phone:325-643-5521
Mailing Address - Fax:325-643-2647
Practice Address - Street 1:2502 CROCKETT DR
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-5900
Practice Address - Country:US
Practice Address - Phone:325-643-5521
Practice Address - Fax:325-643-2647
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-07
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX706322363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00R164Medicare UPIN
TX259890YQPKMedicare UPIN