Healthcare Provider Details

I. General information

NPI: 1285359414
Provider Name (Legal Business Name): LIZZIE A DIAZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 10/10/2022
Certification Date: 10/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

863 NW 123RD CT
MIAMI FL
33182-2418
US

IV. Provider business mailing address

863 NW 123RD CT
MIAMI FL
33182-2418
US

V. Phone/Fax

Practice location:
  • Phone: 305-951-3954
  • Fax:
Mailing address:
  • Phone: 305-951-3954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11022317
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: