| Doctor Name: | CARLA DIANE DIFFENDERFER |
| NPI Number: | 1467880922 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 18523 |
| Business Practice Address: | 3816 Highway 17 S North Myrtle Beach, SC - 295825069 |
| Business Phone Number: | 8432721411 |
| Business Fax Number: | 8432722130 |
| Mailing Address: | 3816 Highway 17 S, NORTH MYRTLE BEACH |
| State: | SC |
| Postal Code: | 295825069 |
| Phone Number: | 8432721411 |
| Fax Number: | 8432722130 |
| NPI Enumeration Date: | 10/21/2013 |
| NPI Last Update Date: | 03/31/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 18523 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |