Healthcare Provider Details

I. General information

NPI: 1104489970
Provider Name (Legal Business Name): EVELYN DIAZ RN, BSN, BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EVELYN PENA BA

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1328 ZUREIQ CT
CLERMONT FL
34714-5900
US

IV. Provider business mailing address

1328 ZUREIQ CT
CLERMONT FL
34714-5900
US

V. Phone/Fax

Practice location:
  • Phone: 407-883-0471
  • Fax:
Mailing address:
  • Phone: 407-883-0471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9609909
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN9609909
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN9609909
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN9609909
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: