Provider Demographics
NPI:1497569404
Name:DIAZ, MICHELLE (NRCPT)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:NRCPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2328 MID TOWN TER APT 1032
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-4527
Mailing Address - Country:US
Mailing Address - Phone:407-535-7684
Mailing Address - Fax:
Practice Address - Street 1:7901 4TH ST N STE 300
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-4399
Practice Address - Country:US
Practice Address - Phone:407-204-1776
Practice Address - Fax:888-272-4513
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLE3222554146N00000X
FLS3F6N6G3202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic