Provider Demographics
NPI:1609236850
Name:SHILLING, DIANE NICOLE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:NICOLE
Last Name:SHILLING
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:DIANE
Other - Middle Name:NICOLE
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1001 SOUTH ANDREWS AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FT. LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316
Mailing Address - Country:US
Mailing Address - Phone:954-906-6000
Mailing Address - Fax:954-860-7650
Practice Address - Street 1:1001 SOUTH ANDREWS AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:FT. LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316
Practice Address - Country:US
Practice Address - Phone:954-906-6000
Practice Address - Fax:954-860-7650
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9266308363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily