Provider Demographics
NPI:1881157824
Name:TAY, DIANE SHER (APRN)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:SHER
Last Name:TAY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2665 PRISON RD 1
Mailing Address - Street 2:ATTN: MEDICAL - TAY
Mailing Address - City:LOVELADY
Mailing Address - State:TX
Mailing Address - Zip Code:75851
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2665 PRISON RD 1
Practice Address - Street 2:
Practice Address - City:LOVELADY
Practice Address - State:TX
Practice Address - Zip Code:75851
Practice Address - Country:US
Practice Address - Phone:936-636-7321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139273363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily