Provider Demographics
NPI:1972618791
Name:MASSUCCI, DIANE J (DNP, ANP-BC)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:J
Last Name:MASSUCCI
Suffix:
Gender:F
Credentials:DNP, ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7966 RIVER ROCK RD
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-2189
Mailing Address - Country:US
Mailing Address - Phone:516-528-7736
Mailing Address - Fax:561-955-5754
Practice Address - Street 1:801 MEADOWS RD STE 117
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2346
Practice Address - Country:US
Practice Address - Phone:561-955-4565
Practice Address - Fax:561-955-5754
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY360346163W00000X
NYF302317 / 360346163W00000X
NYF302317363LA2200X
FL9311818363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY98V951Medicare ID - Type Unspecified