Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | ME89688 | FL |
NPI | 1437155033 |
---|---|
Provider Name | Diane Van De Mark |
First Address | Coral Springs, FL 33065-5742 |
Second Address | Coral Springs, FL 33065-5742 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A66668 | (02) |