Provider Demographics
NPI:1396135844
Name:DIAZ, SANDRA (ARNP, FNP-BC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:ARNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 S PLEASANT GROVE BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-3493
Mailing Address - Country:US
Mailing Address - Phone:800-640-3451
Mailing Address - Fax:
Practice Address - Street 1:8320 W SUNRISE BLVD STE 205
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-5432
Practice Address - Country:US
Practice Address - Phone:800-640-3451
Practice Address - Fax:561-367-8257
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-04
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2014012312363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily