Provider Demographics
NPI:1124492798
Name:DIAZ, GABRIEL (ARNP-BC)
Entity type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:
Last Name:DIAZ
Suffix:
Gender:M
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 W SPRUCE ST
Mailing Address - Street 2:APT 243
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-4149
Mailing Address - Country:US
Mailing Address - Phone:813-598-1438
Mailing Address - Fax:
Practice Address - Street 1:2150 PENNSYLVANIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-3201
Practice Address - Country:US
Practice Address - Phone:202-741-2160
Practice Address - Fax:202-741-2169
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-19
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9323295363LA2200X
DCNP500003630363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016403100Medicaid
P3Y45OtherBCBS ID
FLIM100ZMedicare PIN