Provider Demographics
NPI:1144212127
Name:FLORIN, DIANA LEE (ARNP-C)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LEE
Last Name:FLORIN
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 E 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:HAVANA
Mailing Address - State:FL
Mailing Address - Zip Code:32333-1442
Mailing Address - Country:US
Mailing Address - Phone:850-539-4747
Mailing Address - Fax:850-539-4744
Practice Address - Street 1:602 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:HAVANA
Practice Address - State:FL
Practice Address - Zip Code:32333-1442
Practice Address - Country:US
Practice Address - Phone:850-539-4747
Practice Address - Fax:850-539-4744
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3204542363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264319700Medicaid
FL41724OtherBCBS PROVIDER NUMBER
FL305052100Medicaid
FL41724OtherBCBS PROVIDER NUMBER
FLK3385Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
FL264319700Medicaid