Provider Demographics
NPI:1811591738
Name:FOLKNER, DIANA FAYE
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:FAYE
Last Name:FOLKNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:FAYE
Other - Last Name:ELDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:225 PACER ST NW
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:FL
Mailing Address - Zip Code:33852-9195
Mailing Address - Country:US
Mailing Address - Phone:863-634-0911
Mailing Address - Fax:
Practice Address - Street 1:225 PACER ST NW
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:FL
Practice Address - Zip Code:33852-9195
Practice Address - Country:US
Practice Address - Phone:863-634-0911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant