Provider Demographics
NPI:1740632629
Name:DIAZ, MANUEL A (ARNP, FNP)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:A
Last Name:DIAZ
Suffix:
Gender:M
Credentials:ARNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15252 SW 138TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-1195
Mailing Address - Country:US
Mailing Address - Phone:305-985-8277
Mailing Address - Fax:305-871-0551
Practice Address - Street 1:15252 SW 138TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-1195
Practice Address - Country:US
Practice Address - Phone:305-985-8277
Practice Address - Fax:305-871-0551
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9328295363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily