Healthcare Provider Details

I. General information

NPI: 1508415860
Provider Name (Legal Business Name): ALICIA DIAZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALICIA GALAN RN

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 11/27/2023
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 S SEACREST BLVD
BOYNTON BEACH FL
33435-7969
US

IV. Provider business mailing address

4899 TROPICAL GARDEN DR
BOYNTON BEACH FL
33436-1430
US

V. Phone/Fax

Practice location:
  • Phone: 561-737-7733
  • Fax:
Mailing address:
  • Phone: 786-302-3282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11005873
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9328401
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: