MEDICARE: RUBISER REYES 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	APRN11017849	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	:	1710642475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUBISER REYES DIAZ APRN

Provider Business Mailing Address
First Line	:	8333 NW 53RD ST FL 6
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33166-4783
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4714 N ARMENIA AVE STE 100
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-2603
Country	:	US
Telephone Number	:	813-935-6334
Fax Number	:	816-443-5324

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

Provider Enumeration Date	:	11/07/2021
Last Update Date	:	06/03/2026

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