Healthcare Provider Details

I. General information

NPI: 1225776602
Provider Name (Legal Business Name): JELEN BELEN PENA DIAZ MSN,RN,APRN,PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 NW 82ND AVE
DORAL FL
33126-1011
US

IV. Provider business mailing address

4401 NW 87TH AVE UNIT 334
DORAL FL
33178-2789
US

V. Phone/Fax

Practice location:
  • Phone: 786-420-5924
  • Fax: 786-542-5340
Mailing address:
  • Phone: 786-405-6110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11047630
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: