Provider Demographics
NPI:1831423466
Name:DIAZ, ANTONIO FAUSTO (ARNP)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:FAUSTO
Last Name:DIAZ
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16622 SW 71ST TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-5533
Mailing Address - Country:US
Mailing Address - Phone:305-397-5951
Mailing Address - Fax:
Practice Address - Street 1:16622 SW 71ST TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-5533
Practice Address - Country:US
Practice Address - Phone:305-397-5951
Practice Address - Fax:305-397-5951
Is Sole Proprietor?:No
Enumeration Date:2009-09-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
FLARNP9373483363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No104100000XBehavioral Health & Social Service ProvidersSocial Worker