Provider Demographics
NPI:1962388330
Name:ROARK, DIANE JOYCE (ACAG-NP)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:JOYCE
Last Name:ROARK
Suffix:
Gender:F
Credentials:ACAG-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4759 BELLUE ST
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-1178
Mailing Address - Country:US
Mailing Address - Phone:916-365-3590
Mailing Address - Fax:
Practice Address - Street 1:4759 BELLUE ST
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-1178
Practice Address - Country:US
Practice Address - Phone:916-365-3590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN420692163W00000X
OHAPRN.CNP.0039994363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse