Individual
GLENDA LAVERNE DIAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
41 SPRING BOK LN, THOMASVILLE, GA 31792-0691
(229) 224-4793
Mailing address
41 SPRING BOK LN, THOMASVILLE, GA 31792-0691
(229) 224-4793
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APRN11002023
FL
363LF0000X
Family Nurse Practitioner
RN155906
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN155906
NEW GRADUATED FAMILYNURSE PRACTITIONER
GA
Enumeration date
12/12/2018
Last updated
03/09/2022
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