Provider Demographics
NPI:1245496736
Name:CHIZMAS, DIANNA L (ARNP)
Entity type:Individual
Prefix:
First Name:DIANNA
Middle Name:L
Last Name:CHIZMAS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4421 SUN'N LAKE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-2172
Mailing Address - Country:US
Mailing Address - Phone:863-382-9600
Mailing Address - Fax:863-382-0107
Practice Address - Street 1:4421 SUN'N LAKE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-2172
Practice Address - Country:US
Practice Address - Phone:863-382-9600
Practice Address - Fax:863-382-0107
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3150382363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000099300Medicaid
FL000099300Medicaid