Healthcare Provider Details

I. General information

NPI: 1902525207
Provider Name (Legal Business Name): GABRIELLE MARIA DIAZ DNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3569 ROUND BARN CIR
SANTA ROSA CA
95403-5781
US

IV. Provider business mailing address

3569 ROUND BARN CIR
SANTA ROSA CA
95403-5781
US

V. Phone/Fax

Practice location:
  • Phone: 317-601-6321
  • Fax:
Mailing address:
  • Phone: 317-601-6321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number95267125
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95039823
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: