Healthcare Provider Details

I. General information

NPI: 1871252379
Provider Name (Legal Business Name): DIEGO LEONARDO ZAPATA GRISALES APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DIEGO L ZAPATA

II. Dates (important events)

Enumeration Date: 12/12/2021
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18503 PINES BLVD STE 311
PEMBROKE PINES FL
33029-1406
US

IV. Provider business mailing address

9500 S DADELAND BLVD STE 200
MIAMI FL
33156-2866
US

V. Phone/Fax

Practice location:
  • Phone: 544-992-5059
  • Fax: 855-770-4383
Mailing address:
  • Phone: 865-303-8207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN9428025
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN9428025
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: