Provider Demographics
NPI:1760442867
Name:BECK, DIANE L (CRPNP)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:L
Last Name:BECK
Suffix:
Gender:F
Credentials:CRPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 REGATTA CIR
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-2455
Mailing Address - Country:US
Mailing Address - Phone:850-881-3205
Mailing Address - Fax:
Practice Address - Street 1:1008 REGATTA CIR
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-2455
Practice Address - Country:US
Practice Address - Phone:850-881-3205
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP002314D363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics