Provider Demographics
NPI:1790730794
Name:HAUGE, DIANE HUBERTZ (ARNP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:HUBERTZ
Last Name:HAUGE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:HUBERTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34995-0417
Mailing Address - Country:US
Mailing Address - Phone:772-223-2832
Mailing Address - Fax:772-223-5665
Practice Address - Street 1:500 SE OSCEOLA ST
Practice Address - Street 2:SUITE 100
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2364
Practice Address - Country:US
Practice Address - Phone:772-286-1550
Practice Address - Fax:772-221-0569
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2999642363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY063EOtherBLUE CROSS BLUE SHIELD
FL013012400Medicaid
FL013012400Medicaid