Provider Demographics
NPI:1851729784
Name:DIAZ, EVA (ARNP)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 NE 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4535
Mailing Address - Country:US
Mailing Address - Phone:305-242-1399
Mailing Address - Fax:305-242-9442
Practice Address - Street 1:1408 NE 1ST AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4535
Practice Address - Country:US
Practice Address - Phone:305-242-1399
Practice Address - Fax:305-242-9442
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9345961363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHR570ZMedicare Oscar/Certification