Provider Demographics
NPI:1962127381
Name:DVEYRINA, DIANA (FANURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:DVEYRINA
Suffix:
Gender:F
Credentials:FANURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10710 BEXLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-1213
Mailing Address - Country:US
Mailing Address - Phone:917-444-6088
Mailing Address - Fax:
Practice Address - Street 1:10710 BEXLEY BLVD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1213
Practice Address - Country:US
Practice Address - Phone:917-444-6088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11021484363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily