Provider Demographics
NPI:1083326920
Name:MARTINO, DIANA JEAN
Entity Type:Individual
Prefix:MISS
First Name:DIANA
Middle Name:JEAN
Last Name:MARTINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9230 SE 171 ST COOPER LOOP
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-1816
Mailing Address - Country:US
Mailing Address - Phone:904-327-8988
Mailing Address - Fax:
Practice Address - Street 1:9230 SE 171 ST COOPER LOOP
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-1816
Practice Address - Country:US
Practice Address - Phone:904-327-8988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker