Provider Demographics
NPI:1396341806
Name:COWAN, DIANA HEATHER (RN)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:HEATHER
Last Name:COWAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:HEATHER
Other - Last Name:COWAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1111 PARK CENTRE BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5365
Mailing Address - Country:US
Mailing Address - Phone:305-625-2112
Mailing Address - Fax:305-625-1008
Practice Address - Street 1:1111 PARK CENTRE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-5365
Practice Address - Country:US
Practice Address - Phone:305-625-2112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9273065163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health