Provider Demographics
NPI:1871225359
Name:RIST, DIANNA (APRN)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:
Last Name:RIST
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DIANNA
Other - Middle Name:
Other - Last Name:DARNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 N CATTLEMEN RD STE 220
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6422
Mailing Address - Country:US
Mailing Address - Phone:941-371-6565
Mailing Address - Fax:941-377-7731
Practice Address - Street 1:600 N CATTLEMEN RD STE 220
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6422
Practice Address - Country:US
Practice Address - Phone:941-371-6565
Practice Address - Fax:941-377-7731
Is Sole Proprietor?:No
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11020384363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11020384OtherAPRN LICENSE