Provider Demographics
NPI:1871786103
Name:EDMONSON, DIANA MAUREEN
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:MAUREEN
Last Name:EDMONSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 COLLIER PKWY
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-5286
Mailing Address - Country:US
Mailing Address - Phone:813-948-3986
Mailing Address - Fax:
Practice Address - Street 1:2121 COLLIER PKWY
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-5286
Practice Address - Country:US
Practice Address - Phone:813-948-3986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2008-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9258069363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily