Provider Demographics
NPI:1982172656
Name:MARRON, DIANELLIS (ARNP)
Entity type:Individual
Prefix:
First Name:DIANELLIS
Middle Name:
Last Name:MARRON
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 1:11584 SW 244TH LN
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-4716
Mailing Address - Country:US
Mailing Address - Phone:786-222-8412
Mailing Address - Fax:
Practice Address - Street 1:11584 SW 244TH LN
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-4716
Practice Address - Country:US
Practice Address - Phone:786-222-8412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-11
Last Update Date:2018-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9352965363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health