Provider Demographics
NPI:1285975052
Name:GRAY, DIANE (ARNP)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 PRIMERA BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2193
Mailing Address - Country:US
Mailing Address - Phone:407-333-3040
Mailing Address - Fax:407-333-3496
Practice Address - Street 1:1035 PRIMERA BLVD
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2193
Practice Address - Country:US
Practice Address - Phone:407-333-3040
Practice Address - Fax:407-333-3496
Is Sole Proprietor?:No
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9262794363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care