MEDICARE: ERIKA DIAZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	11003222	FL
2	363LF0000X	Family Nurse Practitioner	11003222	FL

General Provider Information

NPI Number	:	1033762471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIKA DIAZ

Provider Business Mailing Address
First Line	:	857 LA GRAN VIA LN
Second Line	:
City	:	APOPKA
State	:	FL
Zip	:	32703-2609
Country	:	US
Telephone Number	:	407-274-3459
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 REMINGTON RD
Second Line	:
City	:	OAKLAND
State	:	FL
Zip	:	34787-9797
Country	:	US
Telephone Number	:	407-739-2191
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2019
Last Update Date	:	07/23/2019

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Directions to “ ERIKA DIAZ ” Practice Location

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