Healthcare Provider Details

I. General information

NPI: 1982002705
Provider Name (Legal Business Name): ALENA DIAZ DE LA NUEZ MSN, FNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2014
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 W 79TH ST
HIALEAH FL
33014-3234
US

IV. Provider business mailing address

1660 W 79TH ST
HIALEAH FL
33014-3234
US

V. Phone/Fax

Practice location:
  • Phone: 305-773-1113
  • Fax:
Mailing address:
  • Phone: 305-773-1113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11017177
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11017177
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: