Provider Demographics
NPI:1841443249
Name:KEMPER, DIANE MARGARET (CRNP)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:MARGARET
Last Name:KEMPER
Suffix:
Gender:F
Credentials:CRNP
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 947407
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30394-7407
Mailing Address - Country:US
Mailing Address - Phone:941-917-2600
Mailing Address - Fax:941-917-7884
Practice Address - Street 1:1700 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3509
Practice Address - Country:US
Practice Address - Phone:941-917-4896
Practice Address - Fax:941-917-6884
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN226820L363L00000X
PASP010014363LA2100X
FLAPRN11013914363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00724662OtherRAILROAD MEDICARE
PA102265160 0001Medicaid
PA25-1716306OtherGREATWEST
PA25-1716306OtherMULTIPLAN/PHCS
PAKE2085977OtherHIGHMARK BLUE SHIELD
PA50083188OtherCAPITAL BLUECROSS
PARN226820LOtherLICENSE
PA25-1716306OtherINTERGROUP
PA25-1716306OtherFIRST HEALTH
PA867633OtherMEDICARE GROUP #
PA25-1716306OtherDEVON
PA25-1716306OtherHEALTHNET/TRICARE
PA120420410OtherDEPT OF LABOR
PAG920-0113/KDM4CUOtherCAREFIRST
PAG920-0113/KDM4CUOtherCAREFIRST
PA151150LN7Medicare PIN