Provider Demographics
NPI:1891295770
Name:DIAZ, YENNIER (FNP-C)
Entity Type:Individual
Prefix:
First Name:YENNIER
Middle Name:
Last Name:DIAZ
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:YENNIER
Other - Middle Name:
Other - Last Name:DIAZ DE LA ROSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4233 WINDING BROOK DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-6902
Mailing Address - Country:US
Mailing Address - Phone:315-403-5316
Mailing Address - Fax:
Practice Address - Street 1:1205 N JOSEY LN
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-6145
Practice Address - Country:US
Practice Address - Phone:972-242-2726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX939226163W00000X
TX1110214363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse