Provider Demographics
NPI:1376187468
Name:GONZALEZ DIAZ, RICARDO (APRN)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:GONZALEZ DIAZ
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12350 NW 39TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-2414
Mailing Address - Country:US
Mailing Address - Phone:954-248-3422
Mailing Address - Fax:800-970-6020
Practice Address - Street 1:275 18TH ST STE 103
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-0824
Practice Address - Country:US
Practice Address - Phone:954-248-3422
Practice Address - Fax:800-970-6020
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-31
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11004768363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily