Healthcare Provider Details

I. General information

NPI: 1235558131
Provider Name (Legal Business Name): MARIA DIAZ FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2014
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 JOSEPHINE ST STE 3
SPRINGFIELD MA
01108-3323
US

IV. Provider business mailing address

29 JOSEPHINE ST
SPRINGFIELD MA
01108-3323
US

V. Phone/Fax

Practice location:
  • Phone: 413-262-9890
  • Fax:
Mailing address:
  • Phone: 413-262-9890
  • Fax: 413-356-6725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2261021
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP2261021
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberNP2261021
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: