Provider Demographics
NPI:1366953242
Name:DIVINCENZO, SUMMER LYNN (ARNP)
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:LYNN
Last Name:DIVINCENZO
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 1:5851 HOLMBERG RD APT 2011
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4525
Mailing Address - Country:US
Mailing Address - Phone:954-415-5821
Mailing Address - Fax:
Practice Address - Street 1:4430 SHERIDAN ST STE B
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3546
Practice Address - Country:US
Practice Address - Phone:954-963-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9254933363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9254933OtherARNP LICENSE NUMBER