Basic Information
| Provider Information | |||||||||
| NPI: | 1922067347 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BAILEY | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4631 NW 31ST AVE | ||||||||
| Address2: | #127, C/O ANESCO ANESTHESIA ASSOCIATES INC | ||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544855666 | ||||||||
| FaxNumber: | 9544851651 | ||||||||
| Practice Location | |||||||||
| Address1: | 5757 N DIXIE HWY | ||||||||
| Address2: | C/O NORTH RIDGE MEDICAL CENTER | ||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547766000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | ARNP2067462 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.