Provider Demographics
NPI:1063172047
Name:ANDRES, DIANNA MARIA (NP-C)
Entity type:Individual
Prefix:
First Name:DIANNA
Middle Name:MARIA
Last Name:ANDRES
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:DIANNA
Other - Middle Name:MARIA
Other - Last Name:SHEEHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:129 MOUNTAIN OAKS RD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-6027
Mailing Address - Country:US
Mailing Address - Phone:904-307-0720
Mailing Address - Fax:
Practice Address - Street 1:129 MOUNTAIN OAKS RD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-6027
Practice Address - Country:US
Practice Address - Phone:904-307-0720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-18
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP025123363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily