Provider Demographics
NPI:1558665257
Name:SMITH, DIANA LYNN (ARNP)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:SMITH
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 1:3160 SOUTHGATE COMMERCE BLVD
Mailing Address - Street 2:SUITE 64
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-8551
Mailing Address - Country:US
Mailing Address - Phone:407-857-8860
Mailing Address - Fax:407-857-7099
Practice Address - Street 1:3160 SOUTHGATE COMMERCE BLVD
Practice Address - Street 2:SUITE 64
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-8549
Practice Address - Country:US
Practice Address - Phone:407-857-8860
Practice Address - Fax:407-857-7099
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1430632363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics