Provider Demographics
NPI:1598452161
Name:JORGE DIAZ, AIMARA ESPERANZA (APRN)
Entity Type:Individual
Prefix:
First Name:AIMARA
Middle Name:ESPERANZA
Last Name:JORGE DIAZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 NW 192ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-3435
Mailing Address - Country:US
Mailing Address - Phone:786-712-8521
Mailing Address - Fax:
Practice Address - Street 1:1225 NW 192ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-3435
Practice Address - Country:US
Practice Address - Phone:786-712-8521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11025851363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner