Provider Demographics
NPI:1457089930
Name:THOMAS, DIANA LYNNE (APRN)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNNE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4830 NW 43RD ST APT F84
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-4404
Mailing Address - Country:US
Mailing Address - Phone:678-977-7950
Mailing Address - Fax:
Practice Address - Street 1:3235 SW 34TH ST STE 101
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-7502
Practice Address - Country:US
Practice Address - Phone:352-431-3940
Practice Address - Fax:352-431-3173
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-11
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11020859363LP0808X
FLAPRN11020859363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health