Provider Demographics
NPI:1770149726
Name:DIAZ, LAURA E (MSN-FNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:E
Last Name:DIAZ
Suffix:
Gender:
Credentials:MSN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5714 11TH ST N APT 10
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-2344
Mailing Address - Country:US
Mailing Address - Phone:703-401-5413
Mailing Address - Fax:
Practice Address - Street 1:8551 RIXLEW LN STE 100
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-4277
Practice Address - Country:US
Practice Address - Phone:800-683-8313
Practice Address - Fax:502-685-9855
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176339363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30015751410001Medicaid