Provider Demographics
NPI:1053096347
Name:DIAZ ALONSO, MARIELA (ARNP)
Entity type:Individual
Prefix:DR
First Name:MARIELA
Middle Name:
Last Name:DIAZ ALONSO
Suffix:
Gender:
Credentials:ARNP
Other - Prefix:DR
Other - First Name:MARIELA
Other - Middle Name:ISABEL
Other - Last Name:DIAZ ALONSO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:3311 CRAGGY BLUFF PL
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32926-7419
Mailing Address - Country:US
Mailing Address - Phone:321-394-5540
Mailing Address - Fax:
Practice Address - Street 1:1650 SAND LAKE RD STE 114A
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-7712
Practice Address - Country:US
Practice Address - Phone:407-988-1177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11025631363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner