Provider Demographics
NPI:1790218501
Name:DOANE-BUSTETTER, DIANNE ELIZABETH (PMHNP)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:ELIZABETH
Last Name:DOANE-BUSTETTER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4529 W SANCTION RD
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461-7623
Mailing Address - Country:US
Mailing Address - Phone:352-558-8054
Mailing Address - Fax:352-218-8485
Practice Address - Street 1:2440 N ESSEX AVE
Practice Address - Street 2:
Practice Address - City:CITRUS HILLS
Practice Address - State:FL
Practice Address - Zip Code:34442-5320
Practice Address - Country:US
Practice Address - Phone:352-558-8054
Practice Address - Fax:352-218-8485
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-07
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9302481363LP0808X
FL9302481363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health