Provider Demographics
NPI:1871911818
Name:TEAL, DIANE R (CRNP)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:R
Last Name:TEAL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:GULF SHORES
Mailing Address - State:AL
Mailing Address - Zip Code:36542-3432
Mailing Address - Country:US
Mailing Address - Phone:251-968-7379
Mailing Address - Fax:251-968-5960
Practice Address - Street 1:1026 GOODYEAR AVE STE 200
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1194
Practice Address - Country:US
Practice Address - Phone:256-543-3977
Practice Address - Fax:256-413-6330
Is Sole Proprietor?:No
Enumeration Date:2014-04-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL1-128203363L00000X
ALF0214180363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL250274Medicaid