MEDICARE: NIELYS FRANCIS INGLES DIAZ APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN11004583	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013550615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIELYS FRANCIS INGLES DIAZ APRN

Provider Business Mailing Address
First Line	:	4265 NE 16TH ST
Second Line	:
City	:	HOMESTEAD
State	:	FL
Zip	:	33033-6033
Country	:	US
Telephone Number	:	305-781-6286
Fax Number	:

Provider Business Practice Location Address
First Line	:	6705 SW 57TH AVE STE 510
Second Line	:
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-3644
Country	:	US
Telephone Number	:	305-850-9103
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2019
Last Update Date	:	07/23/2020

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