Provider Demographics
NPI:1417931098
Name:HANSELL, DIANA ELAINE (ARNP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:ELAINE
Last Name:HANSELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:ELAINE
Other - Last Name:WALK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:599 9TH ST N
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5623
Mailing Address - Country:US
Mailing Address - Phone:239-435-1999
Mailing Address - Fax:239-435-9697
Practice Address - Street 1:599 9TH ST N
Practice Address - Street 2:SUITE 210
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5623
Practice Address - Country:US
Practice Address - Phone:239-435-1999
Practice Address - Fax:239-435-9697
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1256862363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY6698ZMedicare PIN
S55020Medicare UPIN