Healthcare Provider Details

I. General information

NPI: 1780898502
Provider Name (Legal Business Name): DIANE MARIE KRAWCZYK RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 01/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3981 SW 30TH AVE
FORT LAUDERDALE FL
33312-6816
US

IV. Provider business mailing address

131 NW 51ST ST
FORT LAUDERDALE FL
33309-3210
US

V. Phone/Fax

Practice location:
  • Phone: 954-816-9681
  • Fax:
Mailing address:
  • Phone: 954-789-4082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License Number058687
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: