Individual provider Active NPI

Nicholas Diaz

  • Nurse Practitioner
  • Tampa, FL
National Provider Identifier
1205518065
Registry record updated Sep 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
APRN11028427 Issued in FL
Practice address
2502 W Saint Isabel St
Tampa, FL 33607-6318
Phone
(813) 874-5707
NPI assigned
Aug 2, 2023
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 6, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X APRN11028427 FL Primary
Registered Nurse 163W00000X RN9502733 FL

Addresses

Primary practice location

2502 W Saint Isabel St
Tampa, FL 33607-6318

Mailing address

5556 Silver Sun Dr
Apollo Beach, FL 33572-2085

Other practice location 1

6901 Simmons Loop
Riverview, FL 33578-9498
Phone (813) 302-8000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240731003434 FL Practitioner - Nurse Practitioner 6305383993 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergency Medical Associates of Tampa Bay LLCGroup PAC ID 3678746674, 84 clinicians
Observation Medical Group LLCGroup PAC ID 3779872627, 51 clinicians

Practice addresses (Care Compare)

4501 Bruce B Downs Blvd
Wesley Chapel, FL 33544-9216
Phone (813) 870-4000

6901 Simmons Loop
Riverview, FL 33578-9498
Phone (813) 302-8000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN9502733FLMDRegistered Nurse
APRN11028427FLMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Observation Medical Group LLC CurrentSince May 24, 2024 Accepting new patients
Emergency Medical Associates of Tampa Bay, LLC CurrentSince May 24, 2024 Accepting new patients
Observation Medical Group LLC CurrentSince May 24, 2024 Accepting new patients

Locations

4211 Van Dyke Rd
Lutz, FL 33558
Phone (813) 265-6300

6901 Simmons Loop
Riverview, FL 33578
Phone (813) 302-8000

2502 W Saint Isabel St
Tampa, FL 33607
Phone (813) 874-5707

3001 W Mlk Blvd
Tampa, FL 33607
Phone (813) 361-6778

4501 Bruce B Downs Blvd
Wesley Chapel, FL 33544
Phone (813) 870-4000

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1690934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693958400000",
    "number": "1205518065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5556 SILVER SUN DR",
            "city": "APOLLO BEACH",
            "state": "FL",
            "postal_code": "335722085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2502 W SAINT ISABEL ST",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336076318",
            "telephone_number": "813-874-5707"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6901 Simmons Loop",
            "address_purpose": "LOCATION",
            "city": "Riverview",
            "state": "FL",
            "postal_code": "335789498",
            "country_code": "US",
            "telephone_number": "813-302-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIAZ",
        "first_name": "NICHOLAS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-08-02",
        "last_updated": "2023-09-06",
        "certification_date": "2023-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "APRN11028427",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "FL",
            "license": "RN9502733",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.