Provider Demographics
NPI:1275686032
Name:HUNTLEY, DIANE J (APRN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:J
Last Name:HUNTLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:951 NW 13TH ST STE 2E
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2337
Mailing Address - Country:US
Mailing Address - Phone:561-368-3455
Mailing Address - Fax:561-368-8642
Practice Address - Street 1:951 NW 13TH ST STE 2E
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2337
Practice Address - Country:US
Practice Address - Phone:561-368-3455
Practice Address - Fax:561-368-8642
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2022-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1377572363LA2200X
NYF341102363LF0000X
FL1377572363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q78158Medicare UPIN