Provider Demographics
NPI:1902053143
Name:DEANGELIS, DIANE M (NP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:DEANGELIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:879 WESTCHESTER CIR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-1564
Mailing Address - Country:US
Mailing Address - Phone:419-307-9230
Mailing Address - Fax:
Practice Address - Street 1:1718 PATTERSON ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2926
Practice Address - Country:US
Practice Address - Phone:615-327-1085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32027363L00000X
OHRN256710363L00000X
OH10173NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2935659Medicaid
OH2935659Medicaid