Healthcare Provider Details

I. General information

NPI: 1316589120
Provider Name (Legal Business Name): JENNIXA I DIAZ-TORRES CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2019
Last Update Date: 03/17/2020
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E ROLLINS ST
ORLANDO FL
32803
US

IV. Provider business mailing address

851 TRAFALGAR COURT STE 200E
MAITLAND FL
32751
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-5600
  • Fax:
Mailing address:
  • Phone: 787-460-3813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11006449
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: