MEDICARE: HADRY DIAZ MSN, APRN, FNP-C

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	APRN11023026	FL

General Provider Information

NPI Number	:	1659082220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HADRY DIAZ MSN, APRN, FNP-C

Provider Business Mailing Address
First Line	:	1779 HARBORSIDE CIR
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-8068
Country	:	US
Telephone Number	:	561-670-0243
Fax Number	:

Provider Business Practice Location Address
First Line	:	1779 HARBORSIDE CIR
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-8068
Country	:	US
Telephone Number	:	561-670-0243
Fax Number	:

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

Provider Enumeration Date	:	12/05/2022
Last Update Date	:	12/05/2022

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