Healthcare Provider Details

I. General information

NPI: 1457091001
Provider Name (Legal Business Name): ITALIA FRANCINE DIAZ KORSGAARD DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9980 CENTRAL PARK BLVD N STE 126
BOCA RATON FL
33428-1703
US

IV. Provider business mailing address

9657 VINEYARD CT
BOCA RATON FL
33428-4343
US

V. Phone/Fax

Practice location:
  • Phone: 561-369-7137
  • Fax: 866-554-1851
Mailing address:
  • Phone: 561-350-7836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS22854
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: