Healthcare Provider Details

I. General information

NPI: 1487006201
Provider Name (Legal Business Name): LIAMNY DIAZ VAZQUEZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 XELDA AVE N
LEHIGH ACRES FL
33971-5691
US

IV. Provider business mailing address

5827 CORPORATE WAY
WEST PALM BEACH FL
33407-2000
US

V. Phone/Fax

Practice location:
  • Phone: 585-568-9645
  • Fax:
Mailing address:
  • Phone: 561-844-9443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11033737
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: