Provider Demographics
NPI:1013550615
Name:INGLES DIAZ, NIELYS FRANCIS (APRN)
Entity Type:Individual
Prefix:
First Name:NIELYS
Middle Name:FRANCIS
Last Name:INGLES DIAZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:NIELYS
Other - Middle Name:F
Other - Last Name:INGLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:4265 NE 16TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-6033
Mailing Address - Country:US
Mailing Address - Phone:305-781-6286
Mailing Address - Fax:
Practice Address - Street 1:6705 SW 57TH AVE STE 510
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-3644
Practice Address - Country:US
Practice Address - Phone:305-850-9103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-26
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11004583363LF0000X
FL11004583363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1013550615Medicaid