MEDICARE: DR. DIANA GINNS PHD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	103TC2200X	Clinical Child & Adolescent Psychologist	PY10430	FL

General Provider Information

NPI Number	:	1871940387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANA GINNS PHD

Provider Business Mailing Address
First Line	:	1207 E GIDDENS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-2422
Country	:	US
Telephone Number	:	714-350-7884
Fax Number	:

Provider Business Practice Location Address
First Line	:	5310 N CENTRAL AVE UNIT D
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-2220
Country	:	US
Telephone Number	:	813-498-4301
Fax Number	:

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

Provider Enumeration Date	:	05/16/2016
Last Update Date	:	06/18/2021

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