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NPI Code Detail

MEDICARE: MRS. DIANA HERTEL WALTER PA-C

MEDICARE: MRS. DIANA HERTEL WALTER PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA9102544FL
2363AS0400XSurgical Physician AssistantPA102544FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659367407
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DIANA HERTEL WALTER PA-C
Provider Business Mailing Address
First Line : 455 PINELLAS ST STE 320
Second Line :
City : CLEARWATER
State : FL
Zip : 33756-3369
Country : US
Telephone Number : 727-446-2273
Fax Number : 727-447-5972
Provider Business Practice Location Address
First Line : 455 PINELLAS ST STE 320
Second Line :
City : CLEARWATER
State : FL
Zip : 33756-3369
Country : US
Telephone Number : 727-446-2273
Fax Number : 727-441-4966
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2005
Last Update Date : 04/13/2023

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