Provider Demographics
NPI:1295834083
Name:TERRANOVA, DIANE B (APN)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:B
Last Name:TERRANOVA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4735 OGLETOWN STANTON RD
Mailing Address - Street 2:SUITE 2123 MAP2
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2072
Mailing Address - Country:US
Mailing Address - Phone:302-286-1800
Mailing Address - Fax:302-286-0241
Practice Address - Street 1:4735 OGLETOWN STANTON RD
Practice Address - Street 2:SUITE 2123 MAP2
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2072
Practice Address - Country:US
Practice Address - Phone:302-286-1800
Practice Address - Fax:302-286-0241
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELH-0000164363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000016559Medicaid
DE1000016559Medicaid
DE00B384Medicare ID - Type Unspecified