Provider Demographics
NPI:1528047958
Name:COMADURAN, DIANA R (FNP)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:R
Last Name:COMADURAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 S PARK AVE
Mailing Address - Street 2:#150
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85714-1635
Mailing Address - Country:US
Mailing Address - Phone:520-746-5001
Mailing Address - Fax:520-573-9607
Practice Address - Street 1:3939 S PARK AVE
Practice Address - Street 2:#150
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85714-1635
Practice Address - Country:US
Practice Address - Phone:520-746-5001
Practice Address - Fax:520-573-9607
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN014932363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ760703Medicaid
R10767Medicare UPIN
AZ760703Medicaid