Healthcare Provider Details

I. General information

NPI: 1770269946
Provider Name (Legal Business Name): CHRISTOPHER DIAZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 SE WILLOUGHBY BLVD
STUART FL
34994-5059
US

IV. Provider business mailing address

3501 SE WILLOUGHBY BLVD
STUART FL
34994-5059
US

V. Phone/Fax

Practice location:
  • Phone: 772-288-0304
  • Fax:
Mailing address:
  • Phone: 772-288-0304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License NumberRN9627713
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11033454
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: