Healthcare Provider Details

I. General information

NPI: 1972948073
Provider Name (Legal Business Name): MICHAEL J DIAZ APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 PROGRESS LN
SAINT CLOUD FL
34769-6519
US

IV. Provider business mailing address

4700 MILLENIA BLVD STE 650
ORLANDO FL
32839-6013
US

V. Phone/Fax

Practice location:
  • Phone: 407-680-1811
  • Fax: 347-905-4570
Mailing address:
  • Phone: 407-680-1811
  • Fax: 347-905-4570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number692583
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11046031
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: