Individual provider Active NPI

Diane E Lalley, FNP-BC

  • Family Nurse Practitioner
  • Apollo Beach, FL
National Provider Identifier
1922429794
Registry record updated Mar 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
ARNP9273761 Issued in FL
Practice address
5998 N US Highway 41 Ste a
Apollo Beach, FL 33572-3133
Phone
(813) 751-3570
Fax
(813) 641-9001
NPI assigned
Dec 22, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 16, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X ARNP9273761 FL Primary

Addresses

Primary practice location

5998 N US Highway 41 Ste a
Apollo Beach, FL 33572-3133

Mailing address

5998 N US Highway 41 Ste a
Apollo Beach, FL 33572-3133
Phone (813) 751-3570

Other identifiers 1

IdentifierTypeStateIssuer
108461900MedicaidFL

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20210309001239 FL Practitioner - Nurse Practitioner 5294046561 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
ARNP9273761FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
I.M.P.a.C.T, Medgroup, Inc CurrentSince Nov 1, 2020 Accepting new patients
A Robaina MD PA CurrentSince Nov 29, 2020 Accepting new patients

Locations

5998 N US Highway 41
Ste A
Apollo Beach, FL 33572
Phone (813) 751-3570

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1387670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615852800000",
    "number": "1922429794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5998 N US HIGHWAY 41 STE A",
            "city": "APOLLO BEACH",
            "state": "FL",
            "postal_code": "335723133",
            "telephone_number": "813-751-3570",
            "fax_number": "813-641-9001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5998 N US HIGHWAY 41 STE A",
            "city": "APOLLO BEACH",
            "state": "FL",
            "postal_code": "335723133",
            "telephone_number": "813-751-3570",
            "fax_number": "813-641-9001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LALLEY",
        "first_name": "DIANE",
        "middle_name": "E",
        "name_prefix": "Ms.",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-12-22",
        "last_updated": "2021-03-16",
        "certification_date": "2021-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP9273761",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "108461900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Apollo Beach, FL

Sources for this page

Verify at the official NPI Registry.