Healthcare Provider Details

I. General information

NPI: 1831009943
Provider Name (Legal Business Name): DIACARE SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 EAGLE HARBOR PKWY STE 1
FLEMING ISLAND FL
32003-4827
US

IV. Provider business mailing address

1635 EAGLE HARBOR PKWY STE 1
FLEMING ISLAND FL
32003-4827
US

V. Phone/Fax

Practice location:
  • Phone: 904-541-8225
  • Fax:
Mailing address:
  • Phone: 904-541-8225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: LORI INDRIOLO
Title or Position: MANAGING MEMBER
Credential:
Phone: 904-318-2618