MEDICARE: MASSIEL ALEXANDRA SANTOS DIAZ ARNP

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	363L00000X	Nurse Practitioner	APRN11010165	FL
2	363LF0000X	Family Nurse Practitioner	AP61173621	WA

General Provider Information

NPI Number	:	1063014165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MASSIEL ALEXANDRA SANTOS DIAZ ARNP

Provider Business Mailing Address
First Line	:	PO BOX 3007
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98114-3007
Country	:	US
Telephone Number	:	206-788-3700
Fax Number	:	206-962-3298

Provider Business Practice Location Address
First Line	:	1474 W GRANADA BLVD STE 455
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-8240
Country	:	US
Telephone Number	:	386-231-4685
Fax Number	:	386-231-4687

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

Provider Enumeration Date	:	11/12/2020
Last Update Date	:	12/31/2025

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