Provider Demographics
NPI:1376735670
Name:O'CONNOR, DIANE MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 FENWAY CT
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-5536
Mailing Address - Country:US
Mailing Address - Phone:678-378-8887
Mailing Address - Fax:
Practice Address - Street 1:2620 ELM HILL PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-3108
Practice Address - Country:US
Practice Address - Phone:615-425-4200
Practice Address - Fax:615-425-4201
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN188468363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I500095Medicare UPIN