Healthcare Provider Details

I. General information

NPI: 1003094855
Provider Name (Legal Business Name): LILIA DIAZ PINO PH.D., ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2008
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2703 N PONCE DE LEON BLVD
ST AUGUSTINE FL
32084-2603
US

IV. Provider business mailing address

8001 SW 100TH ST
MIAMI FL
33156-2523
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 786-255-0763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9182489
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: