Provider Demographics
NPI:1992233936
Name:LANE, DIANA M
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:M
Last Name:LANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:PANCIERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7512 DR PHILLIPS BLVD STE 50-792
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5420
Mailing Address - Country:US
Mailing Address - Phone:407-707-5018
Mailing Address - Fax:
Practice Address - Street 1:3030 HARDEN BLVD BLDG 1
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-7952
Practice Address - Country:US
Practice Address - Phone:407-707-5018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT5423208600000X
FLOS20244208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery