Provider Demographics
NPI:1710022819
Name:NANAYAKKARA, DIANA (ACNP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:NANAYAKKARA
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 PRESTON PARK BLVD
Mailing Address - Street 2:SUITE 1450
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3656
Mailing Address - Country:US
Mailing Address - Phone:469-800-4540
Mailing Address - Fax:469-800-4540
Practice Address - Street 1:1820 PRESTON PARK BLVD
Practice Address - Street 2:SUITE 1450
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-3656
Practice Address - Country:US
Practice Address - Phone:469-800-4540
Practice Address - Fax:469-800-4541
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2023-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX582087363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151127202Medicaid
TX151127203Medicaid
TX87N490Medicare PIN
TX87N491Medicare PIN
TX151127202Medicaid
TXP01010988Medicare PIN
TX500024829Medicare PIN
TX500024828Medicare PIN
TXTX B139191Medicare PIN
TX500024826Medicare PIN
TX87N489Medicare PIN
TXP57097Medicare UPIN