Provider Demographics
NPI:1881725794
Name:ZGALJIC, DIANE (RN,MS,ANP-C)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:ZGALJIC
Suffix:
Gender:F
Credentials:RN,MS,ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WOODMONT BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-5250
Mailing Address - Country:US
Mailing Address - Phone:888-987-1151
Mailing Address - Fax:
Practice Address - Street 1:4430 14TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-1425
Practice Address - Country:US
Practice Address - Phone:941-297-2123
Practice Address - Fax:941-297-2210
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3193512363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ093227Medicare ID - Type Unspecified