MEDICARE: ELIZABETH DIAZ APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	26NR19009900	NJ

General Provider Information

NPI Number	:	1457168874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH DIAZ APN

Provider Business Mailing Address
First Line	:	1944 CORLIES AVE STE 206
Second Line	:
City	:	NEPTUNE
State	:	NJ
Zip	:	07753-5197
Country	:	US
Telephone Number	:	732-774-8282
Fax Number	:

Provider Business Practice Location Address
First Line	:	1944 CORLIES AVE STE 206
Second Line	:
City	:	NEPTUNE CITY
State	:	NJ
Zip	:	07753-5197
Country	:	US
Telephone Number	:	732-774-8282
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2024
Last Update Date	:	03/20/2025

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