Provider Demographics
NPI:1780898502
Name:KRAWCZYK, DIANE MARIE (RNFA)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:MARIE
Last Name:KRAWCZYK
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 NW 51ST ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3210
Mailing Address - Country:US
Mailing Address - Phone:954-789-4082
Mailing Address - Fax:
Practice Address - Street 1:3981 SW 30TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6816
Practice Address - Country:US
Practice Address - Phone:954-816-9681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL058687364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN 3003202OtherRNFA