Diana Michelle Petruk, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9108430 Issued in FL

Practice address

1600 S Andrews Ave
Fort Lauderdale, FL 33316-2510

Phone

(954) 355-4400

NPI assigned

Aug 31, 2014

Last updated

Mar 11, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Florida Em-I Medical Services, PA

  • Nurse Practitioner
  • Fort Lauderdale, FL
  • NPI 1316764988

  Physician Assistant

  Medicare reassignment NPD
• Phoenix Emergency Medicine of Broward LLC

  • Emergency Medicine Physician
  • Coral Springs, FL
  • NPI 1871542969
  Medicare reassignment
• Phoenix Emergency Medicine of Broward LLC

  • Emergency Medicine Physician
  • Deerfield Beach, FL
  • NPI 1407805591
  NPD
• Phoenix Emergency Medicine of Broward LLC

  • Emergency Medicine Physician
  • Fort Lauderdale, FL
  • NPI 1992708887
  NPD
• Gulfstream Emergency Physicians

  • Emergency Medicine Physician
  • Aventura, FL
  • NPI 1447428438
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1409443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583884800000",
    "number": "1598165243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 SW 11TH CT",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333151240",
            "telephone_number": "954-663-2583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 S ANDREWS AVE",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333162510",
            "telephone_number": "954-355-4400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5900 College Rd",
            "address_purpose": "LOCATION",
            "city": "Key West",
            "state": "FL",
            "postal_code": "330404342",
            "country_code": "US",
            "telephone_number": "305-294-5531",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETRUK",
        "first_name": "DIANA",
        "middle_name": "MICHELLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-31",
        "last_updated": "2020-03-11",
        "certification_date": "2020-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9108430",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vanessa S Petit, APRN
• Christopher John Petrie, A.P.
• Samantha Shoshana Petrillo, AGACNP-BC
• Jerome J Petrisko, DMD
• Danielle Petrucelli, CCC-SLP
• Mariel Petruk, DDS
• Antonio Petruzzella, PHD
• Stephen Joseph Petteruti, D.O.
• Teresa Petty
• Wendy Susan Petusevsky, RD, LD

• Physician Assistant in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.