Provider Demographics
NPI:1427382761
Name:ST PIERRE, DIANE (ARNP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:ST PIERRE
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 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:15661 SAN CARLOS BLVD UNIT 2
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-2797
Practice Address - Country:US
Practice Address - Phone:239-433-4014
Practice Address - Fax:239-481-6247
Is Sole Proprietor?:No
Enumeration Date:2009-09-18
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN2502672363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP 2502672OtherSTATE LICENSE
FLARNP 2502672OtherSTATE LICENSE