Provider Demographics
NPI:1891581427
Name:ERAZO, DIANE (APRN)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:ERAZO
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 JAZLYN DR
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:TX
Mailing Address - Zip Code:76059-1995
Mailing Address - Country:US
Mailing Address - Phone:817-680-9214
Mailing Address - Fax:
Practice Address - Street 1:117 JAZLYN DR
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:TX
Practice Address - Zip Code:76059-1995
Practice Address - Country:US
Practice Address - Phone:817-680-9214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1194106363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health