Provider Demographics
NPI:1730978156
Name:PATRICK, DIANE
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:PATRICK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 15TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2516
Mailing Address - Country:US
Mailing Address - Phone:561-255-5262
Mailing Address - Fax:
Practice Address - Street 1:6641 CONCH CT
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3648
Practice Address - Country:US
Practice Address - Phone:561-255-5262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant