Provider Demographics
NPI:1730378175
Name:DIANE BRZEZINSKI DO PA
Entity type:Organization
Organization Name:DIANE BRZEZINSKI DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRZEZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:239-261-9990
Mailing Address - Street 1:1250 PINE RIDGE RD STE 101A
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-8913
Mailing Address - Country:US
Mailing Address - Phone:239-261-9990
Mailing Address - Fax:239-261-9993
Practice Address - Street 1:1250 PINE RIDGE RD STE 101A
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-8913
Practice Address - Country:US
Practice Address - Phone:239-261-9990
Practice Address - Fax:239-261-9993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7847207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1447301544OtherIND NPI
FL1447301544OtherNPI
FL1447301544OtherNPI
FLK6633Medicare UPIN
FL46876YMedicare PIN