Healthcare Provider Details

I. General information

NPI: 1689521643
Provider Name (Legal Business Name): MS. ARIANNE CAROLINA DIAZ DOMINGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1228 S PINE ISLAND RD
PLANTATION FL
33324-4566
US

IV. Provider business mailing address

440 LAKEVIEW DR APT 202
WESTON FL
33326-2471
US

V. Phone/Fax

Practice location:
  • Phone: 954-200-2139
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11051416
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9610654
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: