Provider Demographics
NPI:1447301544
Name:BRZEZINSKI, DIANE JOAN (DO)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:JOAN
Last Name:BRZEZINSKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7847207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1730378175OtherNPI
FLK6633Medicare PIN
FLG63857Medicare UPIN
FL46876YMedicare UPIN