Provider Demographics
NPI:1508507245
Name:DIAZ RODRIGUEZ, DACHEL (MSN, FNP)
Entity Type:Individual
Prefix:
First Name:DACHEL
Middle Name:
Last Name:DIAZ RODRIGUEZ
Suffix:
Gender:M
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13412 SW 43RD LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3860
Mailing Address - Country:US
Mailing Address - Phone:786-599-4674
Mailing Address - Fax:
Practice Address - Street 1:13412 SW 43RD LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3860
Practice Address - Country:US
Practice Address - Phone:786-599-4674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11018736363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily