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Individual

MARIA JENNIFER FRANCIS DIAZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
C.R.N.P.

Contact information

Practice address
171 ASHLEY AVENUE, CHARLESTON, SC 29425
(843) 792-1414
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
(843) 792-6200

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
22031
SC
363L00000X
Nurse Practitioner
R112353
MD
363LA2200X
Adult Health Nurse Practitioner
R112353
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
402803100
MD
Enumeration date
06/27/2006
Last updated
08/14/2018
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