Provider Demographics
NPI:1447657895
Name:DIAZ, CRAIG T JR (RNFA)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:T
Last Name:DIAZ
Suffix:JR
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 190287
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-0287
Mailing Address - Country:US
Mailing Address - Phone:888-322-6432
Mailing Address - Fax:888-329-6432
Practice Address - Street 1:5414 BOWSER AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209-6301
Practice Address - Country:US
Practice Address - Phone:888-322-6432
Practice Address - Fax:888-329-6432
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-01
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX799571163WR0006X
TXAP139417363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant