Individual
MS. JESSY DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7700 SW 104TH ST, SUITE 201, PINECREST, FL 33156-3149
(305) 279-7546
Mailing address
7700 SW 104TH ST, PINECREST, FL 33156-3149
(305) 279-7546
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9105581
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA9105581
PHYSICIAN ASSISTANT LICENSE
FL
Enumeration date
11/15/2010
Last updated
03/30/2017
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