Healthcare Provider Details

I. General information

NPI: 1114255270
Provider Name (Legal Business Name): YEDELIS DIAZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2009
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date: 06/04/2021
Reactivation Date: 06/30/2021

III. Provider practice location address

8870 SW 40TH ST STE 4
MIAMI FL
33165-5465
US

IV. Provider business mailing address

8750 SW 41ST ST
MIAMI FL
33165-5433
US

V. Phone/Fax

Practice location:
  • Phone: 786-427-9877
  • Fax:
Mailing address:
  • Phone: 786-427-9877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11005945
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS 4392
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: