Healthcare Provider Details

I. General information

NPI: 1114454246
Provider Name (Legal Business Name): RAQUEL CORREA LIMA DIAZ CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2017
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3641 S MIAMI AVE
MIAMI FL
33133-4204
US

IV. Provider business mailing address

9905 SW 117TH PL
MIAMI FL
33186-2783
US

V. Phone/Fax

Practice location:
  • Phone: 305-854-3636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN9242687
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9242687
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: