Provider Demographics
NPI:1124067889
Name:DIAZ, ANGELA G (CRNA)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:G
Last Name:DIAZ
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:G
Other - Last Name:ACOSTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:7600 W SUNRISE BLVD
Mailing Address - Street 2:MAIL STOP-PL-31
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-4115
Mailing Address - Country:US
Mailing Address - Phone:407-697-8356
Mailing Address - Fax:
Practice Address - Street 1:515 W STATE ROAD 434 STE 105
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5161
Practice Address - Country:US
Practice Address - Phone:407-260-6000
Practice Address - Fax:407-260-2133
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3404772367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114970900Medicaid
FL307655500Medicaid