Healthcare Provider Details

I. General information

NPI: 1922149343
Provider Name (Legal Business Name): DIANA LYNNE SALZBURG LM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 NE 1ST ST STE B
GAINESVILLE FL
32601-5710
US

IV. Provider business mailing address

521 NE 1ST ST STE B
GAINESVILLE FL
32601-5710
US

V. Phone/Fax

Practice location:
  • Phone: 352-377-3879
  • Fax: 352-478-0175
Mailing address:
  • Phone: 352-377-3879
  • Fax: 352-478-0175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW20
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW0020
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: