Provider Demographics
NPI:1871252379
Name:ZAPATA GRISALES, DIEGO LEONARDO (APRN)
Entity Type:Individual
Prefix:
First Name:DIEGO
Middle Name:LEONARDO
Last Name:ZAPATA GRISALES
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:DIEGO
Other - Middle Name:L
Other - Last Name:ZAPATA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9500 S DADELAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2866
Mailing Address - Country:US
Mailing Address - Phone:865-303-8207
Mailing Address - Fax:
Practice Address - Street 1:18503 PINES BLVD STE 311
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-1406
Practice Address - Country:US
Practice Address - Phone:544-992-5059
Practice Address - Fax:855-770-4383
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-12
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9428025363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily