Healthcare Provider Details

I. General information

NPI: 1174221162
Provider Name (Legal Business Name): DANIELA FERNANDEZ DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 12TH AVE
MIAMI FL
33136-1003
US

IV. Provider business mailing address

1400 NW 12TH AVE
MIAMI FL
33136-1003
US

V. Phone/Fax

Practice location:
  • Phone: 305-325-5511
  • Fax: 305-325-4673
Mailing address:
  • Phone: 305-325-5511
  • Fax: 305-325-4673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11024375
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: