Healthcare Provider Details

I. General information

NPI: 1700563152
Provider Name (Legal Business Name): ADYS GUTIERREZ DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7239 US HIGHWAY 301 S
RIVERVIEW FL
33578-4346
US

IV. Provider business mailing address

8333 NW 53RD ST FL 6
DORAL FL
33166-4783
US

V. Phone/Fax

Practice location:
  • Phone: 813-741-2100
  • Fax: 813-741-2003
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11023437
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: