Provider Demographics
NPI:1285010447
Name:DIAZ, AMANDA L (AA)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:L
Last Name:DIAZ
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1901 ULMERTON RD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-2300
Mailing Address - Country:US
Mailing Address - Phone:727-573-7777
Mailing Address - Fax:727-573-7710
Practice Address - Street 1:300 PINELLAS ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3804
Practice Address - Country:US
Practice Address - Phone:727-573-7777
Practice Address - Fax:727-573-7710
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant