Healthcare Provider Details

I. General information

NPI: 1386075794
Provider Name (Legal Business Name): DIANA KOFRON CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 07/22/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6TH MEDICAL GROUP 3250 ZEMKE AVE
TAMPA FL
33621-5023
US

IV. Provider business mailing address

3250 ZEMKE AVE
TAMPA FL
33621-5023
US

V. Phone/Fax

Practice location:
  • Phone: 813-827-9356
  • Fax: 813-827-9658
Mailing address:
  • Phone: 813-827-9549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2013043971
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: