Provider Demographics
NPI:1508211988
Name:DIAZ, CONSUELO (RN)
Entity Type:Individual
Prefix:MS
First Name:CONSUELO
Middle Name:
Last Name:DIAZ
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 1:3001 S OCEAN DR APT 1211
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-2873
Mailing Address - Country:US
Mailing Address - Phone:786-709-5426
Mailing Address - Fax:
Practice Address - Street 1:2500 NW 29TH MANOR
Practice Address - Street 2:
Practice Address - City:POMPANO
Practice Address - State:FL
Practice Address - Zip Code:33069
Practice Address - Country:US
Practice Address - Phone:954-229-1369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN1898032163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse