MEDICARE: AYLEN DIAZ GARCIA APRN

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	363LF0000X	Family Nurse Practitioner	11022299	FL

General Provider Information

NPI Number	:	1306561436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYLEN DIAZ GARCIA APRN

Provider Business Mailing Address
First Line	:	4469 S CONGRESS AVE STE 106
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-4726
Country	:	US
Telephone Number	:	561-642-0768
Fax Number	:

Provider Business Practice Location Address
First Line	:	4469 S CONGRESS AVE STE 106
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-4726
Country	:	US
Telephone Number	:	561-642-0768
Fax Number	:

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

Provider Enumeration Date	:	10/11/2022
Last Update Date	:	06/27/2023

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