Provider Demographics
NPI:1881739282
Name:CAMMARATA, DIANE (APN)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:CAMMARATA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5446 GLEN LAKES DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4308
Mailing Address - Country:US
Mailing Address - Phone:214-750-6664
Mailing Address - Fax:214-750-6671
Practice Address - Street 1:5446 GLEN LAKES DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4308
Practice Address - Country:US
Practice Address - Phone:214-750-6664
Practice Address - Fax:214-750-6671
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70174363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXNP7175Medicare UPIN