Provider Demographics
NPI:1730860545
Name:COUTURE, DIAMANTE LARISA-ALYCE (BSN, RN)
Entity type:Individual
Prefix:MRS
First Name:DIAMANTE
Middle Name:LARISA-ALYCE
Last Name:COUTURE
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:DIAMANTE
Other - Middle Name:LARISA-ALYCE
Other - Last Name:VELEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:36850 COUNTY ROAD 52
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-5199
Mailing Address - Country:US
Mailing Address - Phone:352-524-5500
Mailing Address - Fax:
Practice Address - Street 1:36850 COUNTY ROAD 52
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-5199
Practice Address - Country:US
Practice Address - Phone:352-524-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9577214163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse