Provider Demographics
NPI:1679575591
Name:CAMPBELL, DIANE MARIA (DNP,FNP- BC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIA
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:DNP,FNP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3139 LEBANON PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-2314
Mailing Address - Country:US
Mailing Address - Phone:615-400-4945
Mailing Address - Fax:615-357-0257
Practice Address - Street 1:808 HADLEY AVE
Practice Address - Street 2:
Practice Address - City:OLD HICKORY
Practice Address - State:TN
Practice Address - Zip Code:37138-3121
Practice Address - Country:US
Practice Address - Phone:615-425-4900
Practice Address - Fax:615-425-4922
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2019-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005980363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ72134Medicare UPIN