Provider Demographics
NPI:1801380704
Name:DIAZ, TANIA (ARNP, PPCNP-BC)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:ARNP, PPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOLLOW LN STE 301
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1215
Mailing Address - Country:US
Mailing Address - Phone:919-823-5437
Mailing Address - Fax:
Practice Address - Street 1:2007 WALNUT ST
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-9227
Practice Address - Country:US
Practice Address - Phone:919-823-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC283300363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics