Provider Demographics
NPI:1669230785
Name:HERRAN, DIEGO FERNANDO (FNP)
Entity type:Individual
Prefix:
First Name:DIEGO
Middle Name:FERNANDO
Last Name:HERRAN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2851 W PROSPECT RD UNIT 1204
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-2631
Mailing Address - Country:US
Mailing Address - Phone:954-618-9792
Mailing Address - Fax:
Practice Address - Street 1:2851 W PROSPECT RD UNIT 1204
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-2631
Practice Address - Country:US
Practice Address - Phone:954-618-9792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11029891363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily