MEDICARE: DR. DEISY DIAZ DNP, 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	363LA2200X	Adult Health Nurse Practitioner	ARNP9179779	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427077742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEISY DIAZ DNP, APRN

Provider Business Mailing Address
First Line	:	4691 SW 110TH AVE
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33328-3224
Country	:	US
Telephone Number	:	305-934-7076
Fax Number	:

Provider Business Practice Location Address
First Line	:	6750 TAFT ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-3903
Country	:	US
Telephone Number	:	954-342-9822
Fax Number	:

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	04/20/2020

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