Provider Demographics
NPI:1255451258
Name:TAMASOVICH, DIANE CAROL (ARNP)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:CAROL
Last Name:TAMASOVICH
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 1:1918 PELICAN LANDING BLVD
Mailing Address - Street 2:APT 1115
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-5552
Mailing Address - Country:US
Mailing Address - Phone:941-587-4887
Mailing Address - Fax:
Practice Address - Street 1:2111 W SWANN AVE
Practice Address - Street 2:SUITEN102
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2477
Practice Address - Country:US
Practice Address - Phone:813-254-7227
Practice Address - Fax:813-253-0285
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207RH0003X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3150272OtherARNP
FLE1176ZMedicare UPIN