Provider Demographics
NPI:1043852593
Name:PETERMAN-DIAZ, KIRA ELANA (APRN)
Entity Type:Individual
Prefix:
First Name:KIRA
Middle Name:ELANA
Last Name:PETERMAN-DIAZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KIRA
Other - Middle Name:ELANA
Other - Last Name:PETERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:567 PIAZZA PT
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-5411
Mailing Address - Country:US
Mailing Address - Phone:321-284-6590
Mailing Address - Fax:
Practice Address - Street 1:12201 RESEARCH PKWY STE 300
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-3265
Practice Address - Country:US
Practice Address - Phone:407-823-2744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9392913163WC0200X
FLAPRN11016787363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine