Provider Demographics
NPI:1457168874
Name:DIAZ, ELIZABETH (APN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:DIAZ
Suffix:
Gender:
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1944 CORLIES AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-5197
Mailing Address - Country:US
Mailing Address - Phone:732-774-8282
Mailing Address - Fax:
Practice Address - Street 1:1944 CORLIES AVE STE 206
Practice Address - Street 2:
Practice Address - City:NEPTUNE CITY
Practice Address - State:NJ
Practice Address - Zip Code:07753-5197
Practice Address - Country:US
Practice Address - Phone:732-774-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-18
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR19009900363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care