Provider Demographics
NPI:1427723089
Name:HADDOCK-DIAZ, MELINDA (DNP, APRN, FNP-C)
Entity type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:
Last Name:HADDOCK-DIAZ
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 W POINT DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4003
Mailing Address - Country:US
Mailing Address - Phone:931-237-6139
Mailing Address - Fax:
Practice Address - Street 1:198 OLD FARMERS RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4032
Practice Address - Country:US
Practice Address - Phone:931-358-2900
Practice Address - Fax:931-358-3821
Is Sole Proprietor?:No
Enumeration Date:2021-08-14
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN150229163W00000X
TN30209363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse