Provider Demographics
NPI:1649484684
Name:MAGAZZU, DIANA ANTONIA (PA)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:ANTONIA
Last Name:MAGAZZU
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12957 PALMS WEST DR
Mailing Address - Street 2:SUIT 201
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-4932
Mailing Address - Country:US
Mailing Address - Phone:561-422-7085
Mailing Address - Fax:
Practice Address - Street 1:12957 PALMS WEST DR
Practice Address - Street 2:SUIT 201
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-4932
Practice Address - Country:US
Practice Address - Phone:561-422-7085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA00003679363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical