Provider Demographics
NPI:1043702103
Name:DIAZ, STEPHANY MARIE (ARNP)
Entity Type:Individual
Prefix:
First Name:STEPHANY
Middle Name:MARIE
Last Name:DIAZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 SW 160TH AVE APT 1014
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-5779
Mailing Address - Country:US
Mailing Address - Phone:786-554-1421
Mailing Address - Fax:
Practice Address - Street 1:600 SILKS RUN
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-2569
Practice Address - Country:US
Practice Address - Phone:305-760-1431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9379116363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily