Provider Demographics
NPI:1427077742
Name:DIAZ, DEISY (DNP, APRN)
Entity type:Individual
Prefix:DR
First Name:DEISY
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4691 SW 110TH AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3224
Mailing Address - Country:US
Mailing Address - Phone:305-934-7076
Mailing Address - Fax:
Practice Address - Street 1:6750 TAFT ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-3903
Practice Address - Country:US
Practice Address - Phone:954-342-9822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9179779363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307102200Medicaid
FLQ40378Medicare UPIN
FLU4464ZMedicare PIN
U4464YMedicare PIN