Provider Demographics
NPI:1730153560
Name:MEYER, DIANA L (CRNA)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:L
Last Name:MEYER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:L
Other - Last Name:HAGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11015 SEMINOLE PALM WAY
Mailing Address - Street 2:
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966
Mailing Address - Country:US
Mailing Address - Phone:239-275-5938
Mailing Address - Fax:239-634-2266
Practice Address - Street 1:3949 EVANS AVE
Practice Address - Street 2:STE 102
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9335
Practice Address - Country:US
Practice Address - Phone:239-939-2622
Practice Address - Fax:239-939-0151
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9198103367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00066229OtherRAILROAD MEDICARE
FLG3323OtherBC/BS FL
FLG3323OtherBC/BS FL