MEDICARE: LAURA E. DIAZ MSN-FNP

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	363LF0000X	Family Nurse Practitioner	0024176339	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770149726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA E. DIAZ MSN-FNP

Provider Business Mailing Address
First Line	:	5714 11TH ST N APT 10
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22205-2344
Country	:	US
Telephone Number	:	703-401-5413
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 WALNUT BLVD STE 12&3
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23805-2101
Country	:	US
Telephone Number	:	800-683-8313
Fax Number	:	502-685-9855

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

Provider Enumeration Date	:	05/15/2019
Last Update Date	:	02/02/2026

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