Individual
JUAN DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
13214 PALM BEACH BLVD, FORT MYERS, FL 33905-2025
(239) 694-7887
(239) 694-8941
Mailing address
3434 HANCOCK BRIDGE PKWY STE 301, NORTH FORT MYERS, FL 33903-7099
(877) 856-3774
(239) 599-2612
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PAT 9109751
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020653300
—
FL
Enumeration date
09/26/2016
Last updated
07/21/2022
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