Healthcare Provider Details

I. General information

NPI: 1588825293
Provider Name (Legal Business Name): DIANA GARZA VEGA APRN, NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W 38TH ST
AUSTIN TX
78705-1006
US

IV. Provider business mailing address

928 ISAIAS DR
LEANDER TX
78641-3387
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-1085
  • Fax:
Mailing address:
  • Phone: 512-925-6274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberAP117106
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAP117106
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: