Provider Demographics
NPI:1972633212
Name:MANCINI, DIANE ELIZABETH (ARNP)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:ELIZABETH
Last Name:MANCINI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 N EDINBURGH DR STE 102
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4125
Mailing Address - Country:US
Mailing Address - Phone:407-303-4190
Mailing Address - Fax:407-303-4192
Practice Address - Street 1:100 N EDINBURGH DR STE 102
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4125
Practice Address - Country:US
Practice Address - Phone:407-303-4190
Practice Address - Fax:407-303-4192
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3365482363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308096000Medicaid