Provider Demographics
NPI:1093813529
Name:HYDEN, DIANA CAROL (CRNA)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:CAROL
Last Name:HYDEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1352 NEW FOREST LN
Mailing Address - Street 2:
Mailing Address - City:OSPREY
Mailing Address - State:FL
Mailing Address - Zip Code:34229-6845
Mailing Address - Country:US
Mailing Address - Phone:941-266-2146
Mailing Address - Fax:
Practice Address - Street 1:9275 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-7779
Practice Address - Country:US
Practice Address - Phone:941-266-2146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 145755 / 03616NA367500000X
KY1069935APRN3001677367500000X
FLARNP2597102367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100000550Medicaid
OH0783764Medicaid
OH0783764Medicaid
KY7100000550Medicaid