Provider Demographics
NPI:1912544602
Name:ZIMMERMAN, DIAMOND T (FNP)
Entity Type:Individual
Prefix:
First Name:DIAMOND
Middle Name:T
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13303 LYNDHURST ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-1812
Mailing Address - Country:US
Mailing Address - Phone:512-287-0827
Mailing Address - Fax:
Practice Address - Street 1:13303 LYNDHURST ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78729-1812
Practice Address - Country:US
Practice Address - Phone:512-287-0827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX887700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily