MEDICARE: DIANE M WEEZORAK NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	APRN11009583	FL
2	363LA2200X	Adult Health Nurse Practitioner	F303818	NY

General Provider Information

NPI Number	:	1083627210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE M WEEZORAK NP

Provider Business Mailing Address
First Line	:	938 CYPRESS VILLAGE BLVD STE A
Second Line	:
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-6835
Country	:	US
Telephone Number	:	813-333-5080
Fax Number	:	813-773-7717

Provider Business Practice Location Address
First Line	:	411 COMMERCIAL CT STE C
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34292-1650
Country	:	US
Telephone Number	:	813-333-5080
Fax Number	:	813-773-7717

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	05/18/2026

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