Provider Demographics
NPI:1548759434
Name:DIEZ, VICTORIA L (APRN)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:L
Last Name:DIEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6100 BLUE LAGOON DR STE 365
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-7010
Mailing Address - Country:US
Mailing Address - Phone:786-322-7333
Mailing Address - Fax:
Practice Address - Street 1:10060 NW 7TH ST # 10
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6158
Practice Address - Country:US
Practice Address - Phone:954-606-0110
Practice Address - Fax:954-495-4162
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL9284845363L00000X
FLAPRN9284845363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113680300Medicaid