Provider Demographics
NPI:1386845741
Name:TREVENA, DIANE KATHERINE (ARNP)
Entity Type:Individual
Prefix:MISS
First Name:DIANE
Middle Name:KATHERINE
Last Name:TREVENA
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 1:1065 NW 50TH DR
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-8631
Mailing Address - Country:US
Mailing Address - Phone:954-986-0390
Mailing Address - Fax:954-986-0091
Practice Address - Street 1:3990 SHERIDAN ST
Practice Address - Street 2:SUITE 104
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3661
Practice Address - Country:US
Practice Address - Phone:954-986-0390
Practice Address - Fax:954-986-0091
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2502892363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP2502892OtherSTATE
FLARNP2502892OtherSTATE
FLS89316Medicare UPIN