Provider Demographics
NPI:1316508062
Name:PEGUERO, DIANELYS (APRN)
Entity type:Individual
Prefix:
First Name:DIANELYS
Middle Name:
Last Name:PEGUERO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5460 W 14TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2221
Mailing Address - Country:US
Mailing Address - Phone:786-423-0246
Mailing Address - Fax:
Practice Address - Street 1:5460 W 14TH CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2221
Practice Address - Country:US
Practice Address - Phone:786-423-0246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF06190516363LF0000X
FLAPRN11003101363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily