Provider Demographics
NPI:1518558493
Name:DIAZ, JOZELLE HOPE (FNP)
Entity Type:Individual
Prefix:MS
First Name:JOZELLE
Middle Name:HOPE
Last Name:DIAZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:JOZELLE
Other - Middle Name:HOPE
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:JOZELLE HOPE DIAZ
Mailing Address - Street 1:20 W LINCOLN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-5762
Mailing Address - Country:US
Mailing Address - Phone:516-709-0614
Mailing Address - Fax:
Practice Address - Street 1:20 W LINCOLN AVE STE 101
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5762
Practice Address - Country:US
Practice Address - Phone:516-709-0614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY626615163W00000X
NY347188261QP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care