# MI DYNAMIC MEDICAL GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700777224
- **Authorized official:** IVETTE DIEGUEZ (APRN)
- **Authorized official phone:** (239) 342-6516

## Contact information

- **Practice address:** 1222 SE 47TH ST STE 201, CAPE CORAL, FL 33904-9602
- **Practice address phone:** (239) 342-6516
- **Practice address fax:** (239) 374-8342
- **Mailing address:** 1222 SE 47TH ST STE 201, CAPE CORAL, FL 33904-9602
- **Mailing address phone:** (239) 342-6516
- **Mailing address fax:** (239) 374-8342

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 07/12/2025
- **Last updated:** 01/27/2026