Provider Demographics
NPI:1437635554
Name:SABOGAL, DIANE (ARNP)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:SABOGAL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 W FLAGLER ST APT 2805
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-1616
Mailing Address - Country:US
Mailing Address - Phone:305-343-2485
Mailing Address - Fax:
Practice Address - Street 1:1500 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1051
Practice Address - Country:US
Practice Address - Phone:305-243-0302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9315716363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily