Provider Demographics
NPI:1336454826
Name:CUDWORTH, DIANNE MARIE (ANP-BC)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:MARIE
Last Name:CUDWORTH
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 36TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6592
Mailing Address - Country:US
Mailing Address - Phone:772-567-4311
Mailing Address - Fax:772-794-1474
Practice Address - Street 1:1000 36TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6592
Practice Address - Country:US
Practice Address - Phone:772-567-4311
Practice Address - Fax:772-794-1474
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11030863363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner