Provider Demographics
NPI:1518773506
Name:BANKS, DIANA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 OLD BAINBRIDGE RD APT 623
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-5381
Mailing Address - Country:US
Mailing Address - Phone:850-759-2026
Mailing Address - Fax:
Practice Address - Street 1:1600 OLD BAINBRIDGE RD APT 623
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-5381
Practice Address - Country:US
Practice Address - Phone:850-759-2026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No172A00000XOther Service ProvidersDriver
No174200000XOther Service ProvidersMeals