Provider Demographics
NPI:1235661091
Name:DIAS, PRISCILLA (RN)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:DIAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 S. CONGRESS AVE
Mailing Address - Street 2:JFK MEDICAL CENTER,
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-5860
Mailing Address - Country:US
Mailing Address - Phone:561-548-9275
Mailing Address - Fax:
Practice Address - Street 1:5301 S. CONGRESS AVE
Practice Address - Street 2:JFK MEDICAL CENTER,
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462
Practice Address - Country:US
Practice Address - Phone:561-548-9275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-31
Last Update Date:2018-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9345362367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered