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General NPI Number Information
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NPI Number | 1023034592
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Entity Type | Individual
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Provider Name | SUSAN LEIGH DIAMOND PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 09/27/2011
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Provider Practice Location Address
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Address Line | 5153 N 9TH AVE
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City | PENSACOLA
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State | FL
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Zip | 32504-8785
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Country | US
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Telephone | 850-505-4700
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Fax | 850-505-4711
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Provider Business Mailing Address
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Address Line | PO BOX 191 PROVIDER ENROLLMENT DEPT
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City | ROCKLAND
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State | GA
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Zip | 30384-0001
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Country | US
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Telephone | 904-390-3610
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Fax | 904-288-5890
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9103577
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License Number State | FL
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