Provider Demographics
NPI:1043261365
Name:DIAZ, EILEEN AGNES (ARNP)
Entity type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:AGNES
Last Name:DIAZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4150 NW 9TH CT
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33066-1645
Mailing Address - Country:US
Mailing Address - Phone:954-972-7059
Mailing Address - Fax:954-229-7771
Practice Address - Street 1:5599 N DIXIE HWY
Practice Address - Street 2:VETERANS ADMINISTRATION OPOPC
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-3406
Practice Address - Country:US
Practice Address - Phone:954-229-7604
Practice Address - Fax:954-229-7771
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP715812363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health