Provider Demographics
NPI:1275059339
Name:DIRIN, KEIVAN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:KEIVAN
Middle Name:
Last Name:DIRIN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N MAITLAND AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4499
Mailing Address - Country:US
Mailing Address - Phone:407-660-7150
Mailing Address - Fax:407-660-7108
Practice Address - Street 1:800 N MAITLAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4499
Practice Address - Country:US
Practice Address - Phone:407-660-7150
Practice Address - Fax:407-660-7108
Is Sole Proprietor?:No
Enumeration Date:2017-08-20
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2998642207Q00000X
FLARNP2998642363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine