Healthcare Provider Details

I. General information

NPI: 1083301998
Provider Name (Legal Business Name): DIANA KRISTINE FALISE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 N ORANGE AVE
GREEN COVE SPRINGS FL
32043-2547
US

IV. Provider business mailing address

1302 RIVER ST
PALATKA FL
32177-5042
US

V. Phone/Fax

Practice location:
  • Phone: 904-284-5904
  • Fax: 904-284-5905
Mailing address:
  • Phone: 386-328-0108
  • Fax: 386-325-1086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number11023933
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10046724
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11023934
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: