Provider Demographics
NPI:1346536117
Name:RHYS, DIANA O (ARNP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:O
Last Name:RHYS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-4304
Mailing Address - Country:US
Mailing Address - Phone:386-236-3215
Mailing Address - Fax:386-236-3178
Practice Address - Street 1:105 W CALVIN ST
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-7403
Practice Address - Country:US
Practice Address - Phone:800-539-4228
Practice Address - Fax:386-469-1564
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9251709101YM0800X
FLAPRN9251709363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003792400Medicaid