MEDICARE: DR. VIRMARIE DIAZ FERNANDEZ MD

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	2084P0800X	Psychiatry Physician	21742-875	WI
2	2084P0800X	Psychiatry Physician	22188	NH
3	2084P0800X	Psychiatry Physician	88427	GA
4	2084P0800X	Psychiatry Physician	43314	AL
5	2084P0800X	Psychiatry Physician	ME135999	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NN736	OTHER	FL	MEDICARE HF

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306248075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIRMARIE DIAZ FERNANDEZ MD

Provider Business Mailing Address
First Line	:	7901 4TH ST N STE 5102
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33702-4305
Country	:	US
Telephone Number	:	352-308-1485
Fax Number	:	352-329-4379

Provider Business Practice Location Address
First Line	:	7901 4TH ST N STE 5102
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33702-4305
Country	:	US
Telephone Number	:	352-308-1485
Fax Number	:	352-329-4379

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

Provider Enumeration Date	:	09/24/2014
Last Update Date	:	01/09/2023

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