Healthcare Provider Details

I. General information

NPI: 1043852593
Provider Name (Legal Business Name): KIRA ELANA PETERMAN-DIAZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIRA ELANA PETERMAN RN

II. Dates (important events)

Enumeration Date: 10/16/2019
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12201 RESEARCH PKWY STE 300
ORLANDO FL
32826-3265
US

IV. Provider business mailing address

567 PIAZZA PT
OVIEDO FL
32765-5411
US

V. Phone/Fax

Practice location:
  • Phone: 407-823-2744
  • Fax:
Mailing address:
  • Phone: 321-284-6590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN9392913
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11016787
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: