Provider Demographics
NPI:1720430291
Name:WARNCKE, DIANA (AUD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:WARNCKE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5960 BEACH BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-5113
Mailing Address - Country:US
Mailing Address - Phone:904-399-3323
Mailing Address - Fax:904-399-3360
Practice Address - Street 1:5960 BEACH BLVD STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-5113
Practice Address - Country:US
Practice Address - Phone:904-399-3323
Practice Address - Fax:904-399-3360
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSLP-AU-LIC-11721231H00000X
AZDA10086231H00000X
237600000X
FLAY2932231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter