Provider Demographics
NPI:1952338733
Name:DIAZ, MARIA JENNIFER FRANCIS (CRNP)
Entity Type:Individual
Prefix:
First Name:MARIA JENNIFER
Middle Name:FRANCIS
Last Name:DIAZ
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MARIA JENNIFER
Other - Middle Name:DIAZ
Other - Last Name:REFUGIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 751461
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1461
Mailing Address - Country:US
Mailing Address - Phone:843-792-6200
Mailing Address - Fax:
Practice Address - Street 1:171 ASHLEY AVENUE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425
Practice Address - Country:US
Practice Address - Phone:843-792-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR112353363L00000X, 363LA2200X
SC22031363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD402803100Medicaid
MDKR70G826Medicare PIN
MD177725YXUMedicare PIN
MD402803100Medicaid