Individual
DIANE L SPIVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
10730 MEDLOCK BRIDGE RD STE 110, JOHNS CREEK, GA 30097-2638
(678) 344-8900
(678) 666-5201
Mailing address
1557 JANMAR RD, SNELLVILLE, GA 30078-5686
(678) 344-8900
(678) 666-5201
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
1-117580
AL
363LF0000X
Family Nurse Practitioner
1-117580
AL
363LF0000X
Family Nurse Practitioner
Primary
RN278076
GA
363LW0102X
Women's Health Nurse Practitioner
1-117580
AL
367500000X
Certified Registered Nurse Anesthetist
55532
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-117580
RN LICENSE
AL
01
—
1391784012
RN LICENSE
KS
01
—
55532
RNA LICENSE
KS
01
—
RN278076
RN LICENSE
GA
Enumeration date
11/08/2006
Last updated
03/18/2019
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