Provider Demographics
NPI:1245726546
Name:DIAZ, ANNIE M (FNP-C)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:M
Last Name:DIAZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:M
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1008 MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4212
Mailing Address - Country:US
Mailing Address - Phone:361-668-4279
Mailing Address - Fax:361-668-6309
Practice Address - Street 1:1008 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4212
Practice Address - Country:US
Practice Address - Phone:361-668-4279
Practice Address - Fax:361-668-6309
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX723824363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner