Provider Demographics
NPI:1598847980
Name:JAWORSKI PETITO, DIANE (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:
Last Name:JAWORSKI PETITO
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 DUNWOODIE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-1934
Mailing Address - Country:US
Mailing Address - Phone:631-422-4585
Mailing Address - Fax:
Practice Address - Street 1:201 PRESIDENT ST
Practice Address - Street 2:HEMPSTEAD HIGH HEALTH CENTER
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-4718
Practice Address - Country:US
Practice Address - Phone:516-292-7111
Practice Address - Fax:516-292-4651
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298429-1163W00000X
NYF380742363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse