Individual
DIANA K MARL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
601 E ROLLINS ST, ORLANDO, FL 32803-1248
(407) 609-0095
(407) 609-0096
Mailing address
601 E ROLLINS ST, ORLANDO, FL 32803-1248
(407) 609-0095
(407) 609-0096
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
00517
WV
363A00000X
Physician Assistant
50000868
OH
363A00000X
Physician Assistant
Primary
PA9105415
FL
363AS0400X
Surgical Physician Assistant
50000868
OH
363AS0400X
Surgical Physician Assistant
517
WV
363AS0400X
Surgical Physician Assistant
PA9105415
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
108875500
—
FL
01
—
HF826A
MEDICARE GRP PTAN
FL
Enumeration date
01/11/2007
Last updated
09/24/2024
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