Provider Demographics
NPI:1700386612
Name:DIAZ, MARIA TERESA (FNP-C)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:TERESA
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 1:5184 TEX OAK AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-7822
Mailing Address - Country:US
Mailing Address - Phone:214-266-9770
Mailing Address - Fax:
Practice Address - Street 1:5184 TEX OAK AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7822
Practice Address - Country:US
Practice Address - Phone:469-407-4173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2023-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX939237163W00000X
TX1111402363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse