Healthcare Provider Details

I. General information

NPI: 1558665257
Provider Name (Legal Business Name): DIANA LYNN SMITH ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 01/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3160 SOUTHGATE COMMERCE BLVD SUITE 64
ORLANDO FL
32806-8549
US

IV. Provider business mailing address

3160 SOUTHGATE COMMERCE BLVD SUITE 64
ORLANDO FL
32806-8551
US

V. Phone/Fax

Practice location:
  • Phone: 407-857-8860
  • Fax: 407-857-7099
Mailing address:
  • Phone: 407-857-8860
  • Fax: 407-857-7099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP1430632
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: