Healthcare Provider Details

I. General information

NPI: 1306774021
Provider Name (Legal Business Name): CHARMAINE DIAZ MSN APRN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 POST RD
FAIRFIELD CT
06824-6232
US

IV. Provider business mailing address

425 POST RD
FAIRFIELD CT
06824-6232
US

V. Phone/Fax

Practice location:
  • Phone: 203-254-2021
  • Fax: 302-254-2022
Mailing address:
  • Phone: 203-254-2021
  • Fax: 302-254-2022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number16726
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: