Healthcare Provider Details

I. General information

NPI: 1659974459
Provider Name (Legal Business Name): FELIPE DIAZ RIZO APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14255 SW 42ND ST UNIT 13-A
MIAMI FL
33175-6408
US

IV. Provider business mailing address

14690 SPRING HILL DR STE 101
SPRING HILL FL
34609-8102
US

V. Phone/Fax

Practice location:
  • Phone: 305-306-3400
  • Fax: 305-402-2800
Mailing address:
  • Phone: 352-277-5305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11009968
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: