Healthcare Provider Details

I. General information

NPI: 1255923645
Provider Name (Legal Business Name): DIANE PATRICIA JENKINS-KING RN CRRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2021
Last Update Date: 02/07/2021
Certification Date: 02/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 SW ARCHER RD
GAINESVILLE FL
32608-1316
US

IV. Provider business mailing address

912 NW 101ST DR
GAINESVILLE FL
32606-8030
US

V. Phone/Fax

Practice location:
  • Phone: 352-554-2170
  • Fax:
Mailing address:
  • Phone: 352-682-1577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License NumberRN2802612
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: