Provider Demographics
NPI:1942600747
Name:DIAZ, JOCELYNNE (BA)
Entity Type:Individual
Prefix:MRS
First Name:JOCELYNNE
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:JOCELYNNE
Other - Middle Name:
Other - Last Name:RUIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:1904 MICHIGAN DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-5351
Mailing Address - Country:US
Mailing Address - Phone:786-553-7427
Mailing Address - Fax:
Practice Address - Street 1:801 DOUGLAS AVE STE 208
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-5206
Practice Address - Country:US
Practice Address - Phone:407-830-6412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker