Healthcare Provider Details

I. General information

NPI: 1013566249
Provider Name (Legal Business Name): GYBELY DIAZ-GONZALES APRN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 08/11/2024
Certification Date: 08/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5617 SKYTOP DR
LITHIA FL
33547-4165
US

IV. Provider business mailing address

5617 SKYTOP DR
LITHIA FL
33547-4165
US

V. Phone/Fax

Practice location:
  • Phone: 813-530-4585
  • Fax: 813-605-6053
Mailing address:
  • Phone: 813-530-4585
  • Fax: 813-605-6053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11004047
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: