Provider Demographics
NPI:1801482260
Name:DIAZ, JEERIKA
Entity type:Individual
Prefix:
First Name:JEERIKA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9753 S ORANGE BLOSSOM TRL STE 101
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-8998
Mailing Address - Country:US
Mailing Address - Phone:407-942-8555
Mailing Address - Fax:407-987-3758
Practice Address - Street 1:9753 S ORANGE BLOSSOM TRL STE 101
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-8998
Practice Address - Country:US
Practice Address - Phone:407-942-8555
Practice Address - Fax:407-987-3758
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11010296363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109715500Medicaid