Provider Demographics
NPI:1801624176
Name:IRIARTE, DIRIAM (FNP)
Entity type:Individual
Prefix:
First Name:DIRIAM
Middle Name:
Last Name:IRIARTE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14012 SW 260TH ST APT 104
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6652
Mailing Address - Country:US
Mailing Address - Phone:786-817-4751
Mailing Address - Fax:
Practice Address - Street 1:10710 SW 34TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3615
Practice Address - Country:US
Practice Address - Phone:305-559-3605
Practice Address - Fax:305-559-7287
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11034278363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily