Provider Demographics
NPI:1154646123
Name:STAMP, DIANE ELISABETH (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:ELISABETH
Last Name:STAMP
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
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Mailing Address - Street 1:685 PALM SPRINGS DR
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-7853
Mailing Address - Country:US
Mailing Address - Phone:407-830-5577
Mailing Address - Fax:407-830-4164
Practice Address - Street 1:685 PALM SPRINGS DR
Practice Address - Street 2:SUITE 2A
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-7853
Practice Address - Country:US
Practice Address - Phone:407-830-5577
Practice Address - Fax:407-830-4164
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-02
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9162311363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGT843ZMedicare PIN