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General NPI Number Information
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NPI Number | 1053766212
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Entity Type | Individual
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Provider Name | MICHELLE DIAZ NAZARIO LMHC
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Gender | Female
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Dates
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Enumeration Date | 04/25/2016
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 5325 E STATE ROAD 64 STE B
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City | BRADENTON
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State | FL
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Zip | 34208-5534
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Country | US
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Telephone | 239-690-6906
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Fax |
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Provider Business Mailing Address
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Address Line | 1411 HARNESS HORSE LN APT 302
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City | BRANDON
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State | FL
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Zip | 33511-3847
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Country | US
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Telephone | 727-310-8599
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH23995
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License Number State | FL
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