Provider Demographics
NPI:1841249034
Name:MAGILL, DIANE G (ARNP)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:G
Last Name:MAGILL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 423039
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34742-3039
Mailing Address - Country:US
Mailing Address - Phone:407-343-5914
Mailing Address - Fax:407-343-5963
Practice Address - Street 1:985 SR 436
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-5664
Practice Address - Country:US
Practice Address - Phone:407-831-5252
Practice Address - Fax:407-831-3390
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1703462363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306306200Medicaid
FLS77579Medicare UPIN
FLE2377XMedicare PIN