Provider Demographics
NPI:1629521307
Name:THOMPSON, DIANE M (ARNP)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:M
Last Name:THOMPSON
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 1:4998 10TH AVE N
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-2210
Mailing Address - Country:US
Mailing Address - Phone:561-293-2900
Mailing Address - Fax:561-412-5554
Practice Address - Street 1:4998 10TH AVE N
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-2210
Practice Address - Country:US
Practice Address - Phone:561-293-2900
Practice Address - Fax:561-412-5554
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9287869363LF0000X
CA95006734363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner