Healthcare Provider Details

I. General information

NPI: 1003016288
Provider Name (Legal Business Name): NILKA DIAZ LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 CHAPIN ST
ST AUGUSTINE FL
32084-3347
US

IV. Provider business mailing address

103 CHAPIN ST
ST AUGUSTINE FL
32084-3347
US

V. Phone/Fax

Practice location:
  • Phone: 904-315-4492
  • Fax:
Mailing address:
  • Phone: 904-315-4492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberPN1302381
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: