Healthcare Provider Details

I. General information

NPI: 1174460760
Provider Name (Legal Business Name): ERNESTO FELIPE PEREZ DIAZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 W WATERS AVE
TAMPA FL
33614-1833
US

IV. Provider business mailing address

2510 W WATERS AVE
TAMPA FL
33614-1833
US

V. Phone/Fax

Practice location:
  • Phone: 813-513-2365
  • Fax: 813-944-4972
Mailing address:
  • Phone: 813-513-2365
  • Fax: 813-944-4972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11047188
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: