Active NPI
Anne Marie Diaz
- Nurse Practitioner
- Valdosta, GA
National Provider Identifier
1285101964
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- AG09180071
- Practice address
- 410 Connell Road Suite T
Valdosta, GA 31602-3160 - Phone
- (229) 244-4720
- NPI assigned
- Oct 31, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | AG09180071 | GA | Primary |
Addresses
Primary practice location
410 Connell Road Suite T
Valdosta, GA 31602-3160
Mailing address
410 Connell Rd Ste T
Valdosta, GA 31602-1899
Phone (229) 244-4720
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 059917025 | Other | GA | DRIVERS LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AG09180071 | GA | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1540944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560211200000",
"number": "1285101964",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "410 CONNELL RD STE T",
"city": "VALDOSTA",
"state": "GA",
"postal_code": "316021899",
"telephone_number": "229-244-4720"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "410 CONNELL ROAD SUITE T",
"city": "VALDOSTA",
"state": "GA",
"postal_code": "316023160",
"telephone_number": "229-244-4720"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIAZ",
"first_name": "ANNE",
"middle_name": "MARIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-10-31",
"last_updated": "2019-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "GA",
"license": "AG09180071",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DRIVERS LICENSE",
"identifier": "059917025",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Valdosta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.