Provider Demographics
NPI:1659742633
Name:DIAZ, REBEKAH ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:REBEKAH
Middle Name:ANN
Last Name:DIAZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:REBEKAH
Other - Middle Name:ANN
Other - Last Name:VAN HORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11467 NW 75TH LN
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2328
Mailing Address - Country:US
Mailing Address - Phone:305-302-8314
Mailing Address - Fax:
Practice Address - Street 1:1611 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-585-7090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9341915163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine