Provider Demographics
NPI:1598244667
Name:LANKENAU, DIANA JISELLE (APRN)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:JISELLE
Last Name:LANKENAU
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 S RED RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4029
Mailing Address - Country:US
Mailing Address - Phone:305-297-7014
Mailing Address - Fax:305-297-7014
Practice Address - Street 1:770 SAYBROOK RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4739
Practice Address - Country:US
Practice Address - Phone:888-344-3893
Practice Address - Fax:860-828-0473
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9315391363LF0000X
MARN2362335363LP0808X
FLARNP9315391163WC0400X
CT10431363LP0808X
FLAPRN9315391363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108320400Medicaid