Revenco, Diana

Revenco, Diana is an individual health care provider with primary practice located at 6919 N Dale Mabry Hwy Ste 125 , Tampa FL 33614-3972. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Nuclear Cardiology, Allopathic & Osteopathic Physicians / Cardiovascular Disease. Allopathic & Osteopathic Physicians / Cardiovascular Disease is her primary health care specialty. Revenco, Diana can be contacted via phone (813) 497-9661.

Contact Information

Primary practice address
6919 N Dale Mabry Hwy Ste 125 Tampa FL 33614-3972
Phone: (813) 497-9661
Fax: (813) 615-8468
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Nuclear Cardiology 207UN0901X 15634 New Hampshire
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X MD60668587 Washington
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X ME146373 Florida

Profile Details

NPI number 1386810091
LBN Legal business name Revenco, Diana
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 2nd, 2008
Last updated Sep 15th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1386810091 NPPES
New Hampshire Other P01138997 RR MEDICARE
New Hampshire MEDICAID 3075998 RR MEDICARE
New Hampshire MEDICAID 1386810091 RR MEDICARE

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