Healthcare Provider Details

I. General information

NPI: 1134331523
Provider Name (Legal Business Name): DIANE MARIE PHILLIPS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

350 7TH ST N
NAPLES FL
34102-5754
US

IV. Provider business mailing address

619 10TH ST N
NAPLES FL
34102-8128
US

V. Phone/Fax

Practice location:
  • Phone: 239-436-5000
  • Fax:
Mailing address:
  • Phone: 317-590-8248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN3397052
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: