Healthcare Provider Details

I. General information

NPI: 1104356302
Provider Name (Legal Business Name): BETSY DIAZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date: 09/18/2021
Reactivation Date: 10/18/2021

III. Provider practice location address

67 W RAILROAD ST
SHELLMAN GA
39886-3100
US

IV. Provider business mailing address

1500 1ST AVE N UNIT 3
BIRMINGHAM AL
35203-1866
US

V. Phone/Fax

Practice location:
  • Phone: 229-679-2100
  • Fax:
Mailing address:
  • Phone: 205-545-5088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11042326
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN133959
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-144325
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: