Provider Demographics
NPI:1770126567
Name:DIAZ, YENIELL (DNP, AGPCNP/PMHNP-BC)
Entity type:Individual
Prefix:MR
First Name:YENIELL
Middle Name:
Last Name:DIAZ
Suffix:
Gender:M
Credentials:DNP, AGPCNP/PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15874 SW 66TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-3635
Mailing Address - Country:US
Mailing Address - Phone:786-863-9587
Mailing Address - Fax:
Practice Address - Street 1:15874 SW 66TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-3635
Practice Address - Country:US
Practice Address - Phone:786-863-9587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-23
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11004682363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty