Healthcare Provider Details

I. General information

NPI: 1427669423
Provider Name (Legal Business Name): DIANNA LOUISE TOMPKINS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11820 BEACH BLVD
JACKSONVILLE FL
32246-6670
US

IV. Provider business mailing address

2974 LANTANA LAKES DR E
JACKSONVILLE FL
32246-1816
US

V. Phone/Fax

Practice location:
  • Phone: 904-642-9100
  • Fax:
Mailing address:
  • Phone: 904-631-4016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11012464
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number9430895
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11012464
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: