Provider Demographics
NPI:1679540983
Name:DIAZ, NANNETTE (DPM)
Entity type:Individual
Prefix:DR
First Name:NANNETTE
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 W BEARSS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2100
Mailing Address - Country:US
Mailing Address - Phone:813-960-1517
Mailing Address - Fax:813-962-3278
Practice Address - Street 1:3355 W BEARSS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2100
Practice Address - Country:US
Practice Address - Phone:813-960-1517
Practice Address - Fax:813-962-3278
Is Sole Proprietor?:No
Enumeration Date:2006-03-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3049213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20858177OtherNPI GROUP NUMBER
FL340531100Medicaid
FL340531100Medicaid
FLU3561YMedicare ID - Type Unspecified