Healthcare Provider Details

I. General information

NPI: 1154843936
Provider Name (Legal Business Name): PAOLA ANDREA MUNOZ ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS PAOLA ANDREA DIAZ

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 10/18/2021
Certification Date: 09/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 W FARIS RD STE D
GREENVILLE SC
29605-4296
US

IV. Provider business mailing address

300 E MCBEE AVE STE 401
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-455-9031
  • Fax: 864-455-9014
Mailing address:
  • Phone: 864-522-8602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP60767021
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20955
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: