Healthcare Provider Details

I. General information

NPI: 1508194325
Provider Name (Legal Business Name): SCARLETT R DIAZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2009
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 CROCKETT DR
BROWNWOOD TX
76801-5900
US

IV. Provider business mailing address

2502 CROCKETT DR
BROWNWOOD TX
76801-5900
US

V. Phone/Fax

Practice location:
  • Phone: 325-643-5521
  • Fax: 325-643-2647
Mailing address:
  • Phone: 325-643-5521
  • Fax: 325-643-2647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number706322
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: