Provider Demographics
NPI:1891342911
Name:DIAZ-WHITE, JULIA VERONICA (FNP-C)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:VERONICA
Last Name:DIAZ-WHITE
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 1:215 ROCK TREE CT
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-8555
Mailing Address - Country:US
Mailing Address - Phone:214-957-3235
Mailing Address - Fax:
Practice Address - Street 1:1400 S MAIN ST STE 403
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4913
Practice Address - Country:US
Practice Address - Phone:817-702-6926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX142593363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily