Provider Demographics
NPI:1699339317
Name:FIZETTE, DIANA KAY (PA)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:KAY
Last Name:FIZETTE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MRS
Other - First Name:DIANA
Other - Middle Name:KAY
Other - Last Name:JARRARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 100910
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-4548
Mailing Address - Country:US
Mailing Address - Phone:863-682-7246
Mailing Address - Fax:863-682-5566
Practice Address - Street 1:541 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-5228
Practice Address - Country:US
Practice Address - Phone:863-682-7246
Practice Address - Fax:863-682-5566
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant