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General NPI Number Information
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NPI Number | 1760280655
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Entity Type | Individual
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Provider Name | NICOLE DIAZ
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Gender | Female
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Dates
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Enumeration Date | 03/05/2025
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 4651 SALISBURY RD STE 400
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City | JACKSONVILLE
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State | FL
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Zip | 32256-6187
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Country | US
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Telephone | 533-001-1412
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Fax |
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Provider Business Mailing Address
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Address Line | 6900 SW 40TH ST # 557404
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City | MIAMI
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State | FL
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Zip | 33155-3709
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Country | US
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Telephone |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11038066
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License Number State | FL
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