Healthcare Provider Details

I. General information

NPI: 1083627210
Provider Name (Legal Business Name): DIANE M WEEZORAK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 COMMERCIAL CT STE C
VENICE FL
34292-1650
US

IV. Provider business mailing address

938 CYPRESS VILLAGE BLVD STE A
SUN CITY CENTER FL
33573-6835
US

V. Phone/Fax

Practice location:
  • Phone: 813-333-5080
  • Fax: 813-773-7717
Mailing address:
  • Phone: 813-333-5080
  • Fax: 813-773-7717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberAPRN11009583
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF303818
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: