Provider Demographics
NPI:1700630522
Name:SCRUGGS, DIANA CATALINA (APRN)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:CATALINA
Last Name:SCRUGGS
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 1:22539 SW 88TH PATH
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1299
Mailing Address - Country:US
Mailing Address - Phone:202-621-4037
Mailing Address - Fax:
Practice Address - Street 1:22539 SW 88TH PATH
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190-1299
Practice Address - Country:US
Practice Address - Phone:202-621-4037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11031339363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty