Provider Demographics
NPI:1679088017
Name:DIAZ, GLORIMAR RIVERA (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:GLORIMAR
Middle Name:RIVERA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:GLORIMAR
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:33 TUNXIS VLG
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1517
Mailing Address - Country:US
Mailing Address - Phone:229-292-7266
Mailing Address - Fax:
Practice Address - Street 1:2 BATTERSON PARK RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2568
Practice Address - Country:US
Practice Address - Phone:860-321-7082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7391363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily