Provider Demographics
NPI:1245915248
Name:RECILLEZ DIAZ, GISEL (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:GISEL
Middle Name:
Last Name:RECILLEZ DIAZ
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11847 GLOBE ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-6393
Mailing Address - Country:US
Mailing Address - Phone:407-675-1485
Mailing Address - Fax:
Practice Address - Street 1:11847 GLOBE ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-6393
Practice Address - Country:US
Practice Address - Phone:407-675-1485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11026892363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily