Provider Demographics
NPI:1740818442
Name:MOORE, DIAMOND NICOLE (DNP, CRNA, APRN)
Entity type:Individual
Prefix:
First Name:DIAMOND
Middle Name:NICOLE
Last Name:MOORE
Suffix:
Gender:F
Credentials:DNP, CRNA, APRN
Other - Prefix:
Other - First Name:DIAMOND
Other - Middle Name:NICOLE
Other - Last Name:RUDDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, CRNA, APRN
Mailing Address - Street 1:8356 BAYWOOD VISTA DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-6625
Mailing Address - Country:US
Mailing Address - Phone:352-598-7293
Mailing Address - Fax:
Practice Address - Street 1:8356 BAYWOOD VISTA DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-6625
Practice Address - Country:US
Practice Address - Phone:352-598-7293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-29
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9405169163W00000X
390200000X
FLAPRN11019593367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program