Healthcare Provider Details

I. General information

NPI: 1386845741
Provider Name (Legal Business Name): DIANE KATHERINE TREVENA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 SHERIDAN ST SUITE 104
HOLLYWOOD FL
33021-3661
US

IV. Provider business mailing address

1065 NW 50TH DR
POMPANO BEACH FL
33064-8631
US

V. Phone/Fax

Practice location:
  • Phone: 954-986-0390
  • Fax: 954-986-0091
Mailing address:
  • Phone: 954-986-0390
  • Fax: 954-986-0091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP2502892
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: