Provider Demographics
NPI:1821292038
Name:ROARK, DIANA LYNN (NP)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:LYNN
Last Name:ROARK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:LYNN
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1949 GUNBARREL ROAD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421
Mailing Address - Country:US
Mailing Address - Phone:423-495-4345
Mailing Address - Fax:423-495-4934
Practice Address - Street 1:2525 DESALES AVENUE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404
Practice Address - Country:US
Practice Address - Phone:423-495-7404
Practice Address - Fax:423-485-2625
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000012256363LF0000X
TN12256363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily