Provider Demographics
NPI:1841279148
Name:OBRADOVIC, DIANA C (PA-C)
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:C
Last Name:OBRADOVIC
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:CHRISTIE OLSEN
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4881 NW 8TH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4582
Mailing Address - Country:US
Mailing Address - Phone:352-416-1082
Mailing Address - Fax:352-373-6144
Practice Address - Street 1:4343 W NEWBERRY RD
Practice Address - Street 2:SUITE 10
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2825
Practice Address - Country:US
Practice Address - Phone:352-373-2340
Practice Address - Fax:352-373-3140
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102499363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL122670500Medicaid
FLQ07732Medicare UPIN