Individual
DIANA MICHELLE PETRUK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1600 S ANDREWS AVE, FORT LAUDERDALE, FL 33316-2510
(954) 355-4400
Mailing address
17 SW 11TH CT, FORT LAUDERDALE, FL 33315-1240
(954) 663-2583
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9108430
FL
Other
Enumeration date
08/31/2014
Last updated
03/11/2020
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