Provider Demographics
NPI:1922799857
Name:LUNA, DIANA R (APRN)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:R
Last Name:LUNA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:R
Other - Last Name:LUNA GUTIERREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:144 NW 16TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-3209
Mailing Address - Country:US
Mailing Address - Phone:832-923-1728
Mailing Address - Fax:
Practice Address - Street 1:10260 SW 56TH ST STE 103
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7021
Practice Address - Country:US
Practice Address - Phone:305-603-9519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11025750363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty