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General NPI Number Information
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NPI Number | 1871911818
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Entity Type | Individual
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Provider Name | DIANE R TEAL CRNP
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Gender | Female
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Dates
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Enumeration Date | 04/06/2014
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Last Update Date | 09/06/2024
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Provider Practice Location Address
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Address Line | 1026 GOODYEAR AVE STE 200
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City | GADSDEN
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State | AL
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Zip | 35903-1194
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Country | US
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Telephone | 256-543-3977
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Fax | 256-413-6330
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Provider Business Mailing Address
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Address Line | 200 OFFICE PARK DR
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City | GULF SHORES
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State | AL
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Zip | 36542-3432
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Country | US
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Telephone | 251-968-7379
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Fax | 251-968-5960
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1-128203
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License Number State | AL
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