Healthcare Provider Details

I. General information

NPI: 1306561436
Provider Name (Legal Business Name): AYLEN DIAZ GARCIA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AYLEN DIAZ GARCIA

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4469 S CONGRESS AVE STE 106
PALM SPRINGS FL
33461-4726
US

IV. Provider business mailing address

4469 S CONGRESS AVE STE 106
PALM SPRINGS FL
33461-4726
US

V. Phone/Fax

Practice location:
  • Phone: 561-642-0768
  • Fax:
Mailing address:
  • Phone: 561-642-0768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11022299
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: