MEDICARE: MRS. DIANE T FREDERICK FNP-C

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	363LF0000X	Family Nurse Practitioner	SP015164	PA

General Provider Information

NPI Number	:	1972971844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANE T FREDERICK FNP-C

Provider Business Mailing Address
First Line	:	601 TAYLOR ST
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37208-2635
Country	:	US
Telephone Number	:	270-999-2731
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 W LEHIGH AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19133-1640
Country	:	US
Telephone Number	:	267-273-7000
Fax Number	:

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

Provider Enumeration Date	:	09/09/2015
Last Update Date	:	05/21/2024

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