Provider Demographics
NPI:1942819669
Name:DIAZ, LIDIA (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:LIDIA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 NW 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1013
Mailing Address - Country:US
Mailing Address - Phone:305-243-6641
Mailing Address - Fax:305-243-6708
Practice Address - Street 1:1580 NW 10TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1013
Practice Address - Country:US
Practice Address - Phone:305-243-6641
Practice Address - Fax:305-243-6708
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11004941363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner