Provider Demographics
NPI:1639868532
Name:RODRIGUEZ DIAZ, AMNIELLYS (APRN, FNP)
Entity Type:Individual
Prefix:
First Name:AMNIELLYS
Middle Name:
Last Name:RODRIGUEZ DIAZ
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14851 SW 114TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-2570
Mailing Address - Country:US
Mailing Address - Phone:786-853-1619
Mailing Address - Fax:
Practice Address - Street 1:14851 SW 114TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-2570
Practice Address - Country:US
Practice Address - Phone:786-853-1619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9547334363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty