MEDICARE: CARLOS MANUEL SANTANA DIAZ

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	11007844	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	:	1073130159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS MANUEL SANTANA DIAZ

Provider Business Mailing Address
First Line	:	28944 LONG MEADOW LOOP
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33543-6472
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8340 STONE RUN CT
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-1879
Country	:	US
Telephone Number	:	813-712-1726
Fax Number	:	813-925-4640

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

Provider Enumeration Date	:	07/06/2020
Last Update Date	:	03/08/2023

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