Provider Demographics
NPI:1427010552
Name:COPENHAVER, DIANNE GLADYS (ARNP)
Entity Type:Individual
Prefix:MISS
First Name:DIANNE
Middle Name:GLADYS
Last Name:COPENHAVER
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 1:8750 SW HIGHWAY 200
Mailing Address - Street 2:SUITEE 103
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34481-7810
Mailing Address - Country:US
Mailing Address - Phone:352-861-5444
Mailing Address - Fax:352-861-5447
Practice Address - Street 1:8750 SW HIGHWAY 200
Practice Address - Street 2:SUITE 103
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481-7810
Practice Address - Country:US
Practice Address - Phone:352-861-5444
Practice Address - Fax:352-861-5447
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3051262363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY9176OtherBCBS OF FL
FLP49648Medicare UPIN