Provider Demographics
NPI:1588455380
Name:PACHECO DIAZ, ERNESTO ANTONIO (APRN)
Entity type:Individual
Prefix:
First Name:ERNESTO
Middle Name:ANTONIO
Last Name:PACHECO DIAZ
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18518 QUINCE RD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33967-6150
Mailing Address - Country:US
Mailing Address - Phone:239-255-3936
Mailing Address - Fax:
Practice Address - Street 1:18518 QUINCE RD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33967-6150
Practice Address - Country:US
Practice Address - Phone:239-255-3936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11039314363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner