MEDICARE: IVETTE DIEGUEZ 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN11005943	FL
2	163W00000X	Registered Nurse	9441637	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	:	1174154926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVETTE DIEGUEZ APRN

Provider Business Mailing Address
First Line	:	9712 SW 132ND PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-2239
Country	:	US
Telephone Number	:	786-800-4563
Fax Number	:

Provider Business Practice Location Address
First Line	:	9712 SW 132ND PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-2239
Country	:	US
Telephone Number	:	786-800-4563
Fax Number	:

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

Provider Enumeration Date	:	01/30/2020
Last Update Date	:	07/12/2025

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