Individual provider Active NPI

Diane Haynes

  • Family Nurse Practitioner
  • Flushing, NY
National Provider Identifier
1790338382
Registry record updated Mar 31, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
358027 Issued in NY
Practice address
3712 Prince St Ste 3C
Flushing, NY 11354-4650
Phone
(718) 380-7800
NPI assigned
Jul 23, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 358027 NY Primary
Registered Nurse 163W00000X 708471 NY

Addresses

Primary practice location

3712 Prince St Ste 3C
Flushing, NY 11354-4650

Mailing address

419 Coolidge Ave
Rockville Centre, NY 11570-3307

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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

Enrollment IDStateProvider typePAC IDDetails
I20260422001382 NY Practitioner - Nurse Practitioner 1951878495 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

419 Coolidge Ave
Rockville Centre, NY 11570-3307

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
708471NYMDRegistered Nurse
358027NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Nova Medical PLLC CurrentSince Mar 31, 2026 Accepting new patients

Locations

3712 Prince St
Ste 3C
Flushing, NY 11354
Phone (718) 380-7800

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1563840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774915200000",
    "number": "1790338382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "419 COOLIDGE AVE",
            "city": "ROCKVILLE CENTRE",
            "state": "NY",
            "postal_code": "115703307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3712 PRINCE ST STE 3C",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113544650",
            "telephone_number": "718-380-7800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAYNES",
        "first_name": "DIANE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-23",
        "last_updated": "2026-03-31",
        "certification_date": "2026-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "358027",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "708471",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flushing, NY

Sources for this page

Verify at the official NPI Registry.