Provider Demographics
NPI:1447951967
Name:DIAZ DIAZ, YANARA (APRN FNP)
Entity type:Individual
Prefix:
First Name:YANARA
Middle Name:
Last Name:DIAZ DIAZ
Suffix:
Gender:F
Credentials:APRN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4725 SW 62ND AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-4461
Mailing Address - Country:US
Mailing Address - Phone:954-638-3484
Mailing Address - Fax:
Practice Address - Street 1:4725 SW 62ND AVE APT 104
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-4461
Practice Address - Country:US
Practice Address - Phone:954-638-3484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF02231148363LF0000X
FL11025028363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily