MEDICARE: DR. NANNETTE DIAZ DPM

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	213ES0131X	Foot Surgery Podiatrist	PO3049	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20858177	OTHER	FL	NPI GROUP NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679540983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANNETTE DIAZ DPM

Provider Business Mailing Address
First Line	:	3355 W BEARSS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2100
Country	:	US
Telephone Number	:	813-960-1517
Fax Number	:	813-962-3278

Provider Business Practice Location Address
First Line	:	3355 W BEARSS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2100
Country	:	US
Telephone Number	:	813-960-1517
Fax Number	:	813-962-3278

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

Provider Enumeration Date	:	03/06/2006
Last Update Date	:	02/06/2014

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