Provider Demographics
NPI:1922067347
Name:BAILEY, DIANE M (CRNA)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:BAILEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:4631 NW 31ST AVE
Mailing Address - Street 2:#127, C/O ANESCO ANESTHESIA ASSOCIATES INC
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309
Mailing Address - Country:US
Mailing Address - Phone:954-485-5666
Mailing Address - Fax:954-485-1651
Practice Address - Street 1:5757 N DIXIE HWY
Practice Address - Street 2:C/O NORTH RIDGE MEDICAL CENTER
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33334
Practice Address - Country:US
Practice Address - Phone:954-776-6000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2067462367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE1796WMedicare ID - Type Unspecified