Provider Demographics
NPI:1992425912
Name:REYES IZQUIERDO, DIANA ROSA (APRN)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:ROSA
Last Name:REYES IZQUIERDO
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 1:13231 SW 272ND LN
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8584
Mailing Address - Country:US
Mailing Address - Phone:954-995-6557
Mailing Address - Fax:
Practice Address - Street 1:13231 SW 272ND LN
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-8584
Practice Address - Country:US
Practice Address - Phone:954-995-6557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9515914163W00000X
FL11020876363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse