Healthcare Provider Details

I. General information

NPI: 1225758337
Provider Name (Legal Business Name): EDWARD DIAZ APRN, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5979 VINELAND RD STE 109
ORLANDO FL
32819-7857
US

IV. Provider business mailing address

2480 CHERRY LAUREL DR APT 402
SANFORD FL
32771-8860
US

V. Phone/Fax

Practice location:
  • Phone: 407-340-6640
  • Fax: 321-275-3720
Mailing address:
  • Phone: 407-443-5577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11021878
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: