Healthcare Provider Details

I. General information

NPI: 1215653589
Provider Name (Legal Business Name): YANET FERNANDEZ DIAZ PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 W WATERS AVE STE 102
TAMPA FL
33614-2869
US

IV. Provider business mailing address

3105 W WATERS AVE STE 102
TAMPA FL
33614-2869
US

V. Phone/Fax

Practice location:
  • Phone: 813-269-2920
  • Fax: 813-269-2921
Mailing address:
  • Phone: 813-269-2920
  • Fax: 813-269-2921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11020420
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11020420
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: