Healthcare Provider Details

I. General information

NPI: 1962399709
Provider Name (Legal Business Name): ANA BERROCAL DIAZ MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11399 LAKE UNDERHILL RD
ORLANDO FL
32825-5023
US

IV. Provider business mailing address

5332 CYPRESS RESERVE PL
WINTER PARK FL
32792-9429
US

V. Phone/Fax

Practice location:
  • Phone: 407-207-6768
  • Fax: 407-249-5025
Mailing address:
  • Phone: 631-215-6705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11040395
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: