Provider Demographics
NPI:1649503798
Name:WINTERS, DIANE K (RN)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:K
Last Name:WINTERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9819 HOPKINS LN
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32466-2930
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2814 W 15TH ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-1322
Practice Address - Country:US
Practice Address - Phone:850-872-4840
Practice Address - Fax:850-872-4446
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN3162492163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management