Provider Demographics
NPI:1780896696
Name:GARIB, DIANE MARIE (ACNP)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:MARIE
Last Name:GARIB
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 FANNIN ST # B452
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2703
Mailing Address - Country:US
Mailing Address - Phone:713-441-3620
Mailing Address - Fax:713-790-2082
Practice Address - Street 1:6565 FANNIN ST # B452
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-441-3620
Practice Address - Fax:713-790-2082
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX720742363L00000X, 363LA2100X
TXAP114346363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX281683703Medicaid
TXP01254127OtherMEDICARE RR
TX281683704Medicaid
TX281683701Medicaid
TXP01092507OtherRR MEDICARE
TX1780896696OtherBLUE CROSS BLUE SHIELD
TX281683702Medicaid
TXP01254127OtherMEDICARE RR
TX281683702Medicaid