Provider Demographics
NPI:1215653589
Name:FERNANDEZ DIAZ, YANET
Entity type:Individual
Prefix:
First Name:YANET
Middle Name:
Last Name:FERNANDEZ DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8416 N ASHLEY ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-1321
Mailing Address - Country:US
Mailing Address - Phone:786-468-6442
Mailing Address - Fax:
Practice Address - Street 1:6916 W LINEBAUGH AVE STE 102
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-5815
Practice Address - Country:US
Practice Address - Phone:813-269-2920
Practice Address - Fax:813-269-2921
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11020420363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner