Provider Demographics
NPI:1831727783
Name:CARR, DIANE MARIE (DO)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:MARIE
Last Name:CARR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4877 MERLIN CIR
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33523-9127
Mailing Address - Country:US
Mailing Address - Phone:254-624-6587
Mailing Address - Fax:
Practice Address - Street 1:2460 N INTERSTATE HIGHWAY 35 E STE 230
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-5274
Practice Address - Country:US
Practice Address - Phone:615-562-9689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXV8218207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program