Provider Demographics
NPI:1306248075
Name:DIAZ FERNANDEZ, VIRMARIE (MD)
Entity type:Individual
Prefix:DR
First Name:VIRMARIE
Middle Name:
Last Name:DIAZ FERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 4TH ST N STE 5102
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-4305
Mailing Address - Country:US
Mailing Address - Phone:352-308-1485
Mailing Address - Fax:352-329-4379
Practice Address - Street 1:7901 4TH ST N STE 5102
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-4305
Practice Address - Country:US
Practice Address - Phone:352-308-1485
Practice Address - Fax:352-329-4379
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21742-8752084P0800X
NH221882084P0800X
GA884272084P0800X
AL433142084P0800X
FLME1359992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLNN736OtherMEDICARE HF
FL104725400Medicaid