Healthcare Provider Details

I. General information

NPI: 1568328730
Provider Name (Legal Business Name): DYAN SYNTHA PHIPPS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2025
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11120 NW GAINESVILLE RD
OCALA FL
34482-1479
US

IV. Provider business mailing address

10171 SW 46TH CT
OCALA FL
34476-4067
US

V. Phone/Fax

Practice location:
  • Phone: 352-690-8746
  • Fax:
Mailing address:
  • Phone: 352-690-8746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11044523
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: