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General NPI Number Information
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NPI Number | 1417197633
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Entity Type | Individual
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Provider Name | DIANNE LYNNE MAZZO ARNP
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Gender | Female
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Dates
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Enumeration Date | 02/27/2009
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Last Update Date | 02/25/2026
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Provider Practice Location Address
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Address Line | 2 MCCORMICK DR
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City | PALM COAST
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State | FL
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Zip | 32164-2352
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Country | US
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Telephone | 386-246-7365
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Fax |
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Provider Business Mailing Address
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Address Line | 2460 OLD MOULTRIE RD STE 1
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-4198
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Country | US
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Telephone | 386-264-1130
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95025681
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN9284326
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License Number State | FL
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