MEDICARE: NIDIA M DIAZ 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	11028766	FL

General Provider Information

NPI Number	:	1639980709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIDIA M DIAZ APRN

Provider Business Mailing Address
First Line	:	2194 W 60TH ST APT 22208
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-2651
Country	:	US
Telephone Number	:	305-244-2282
Fax Number	:

Provider Business Practice Location Address
First Line	:	2194 W 60TH ST APT 22208
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-2651
Country	:	US
Telephone Number	:	305-244-2282
Fax Number	:

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

Provider Enumeration Date	:	01/16/2025
Last Update Date	:	01/16/2025

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Directions to “ NIDIA M DIAZ APRN” Practice Location

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