Healthcare Provider Details

I. General information

NPI: 1124492798
Provider Name (Legal Business Name): GABRIEL DIAZ ARNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2015
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 PENNSYLVANIA AVE NW
WASHINGTON DC
20037-3201
US

IV. Provider business mailing address

4400 W SPRUCE ST APT 243
TAMPA FL
33607-4149
US

V. Phone/Fax

Practice location:
  • Phone: 202-741-2160
  • Fax: 202-741-2169
Mailing address:
  • Phone: 813-598-1438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP 9323295
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberNP500003630
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: