Provider Demographics
NPI:1831237924
Name:DIAZ, ASHLEY W (CRNA)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:W
Last Name:DIAZ
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ASHELY
Other - Middle Name:N
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:4901 GRANDE DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-5935
Mailing Address - Country:US
Mailing Address - Phone:850-477-7042
Mailing Address - Fax:850-474-9060
Practice Address - Street 1:4901 GRANDE DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-5935
Practice Address - Country:US
Practice Address - Phone:850-477-7042
Practice Address - Fax:850-474-9060
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9254112367500000X
AL1-095731367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308150800Medicaid
FLG4162OtherBLUE CROSS BLUE SHIELD
AL009941877Medicaid
AL591-91312OtherBLUE CROSS BLUE SHIELD
FLG4162OtherBLUE CROSS BLUE SHIELD