Healthcare Provider Details

I. General information

NPI: 1861001919
Provider Name (Legal Business Name): DEBORAH DIAZ TELESFORD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2020
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10709 PLEASANT KNOLL DR
TAMPA FL
33647-3667
US

IV. Provider business mailing address

2191 9TH AVE N STE 110
ST PETERSBURG FL
33713-7147
US

V. Phone/Fax

Practice location:
  • Phone: 813-405-9804
  • Fax:
Mailing address:
  • Phone: 727-820-7778
  • Fax: 727-820-7779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11008243
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11008243
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: