Healthcare Provider Details

I. General information

NPI: 1700390861
Provider Name (Legal Business Name): DYMAN CHRISTIAN KWARCIAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DYMAN CHRISTIAN SHEPHERD

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 SAN PABLO RD S
JACKSONVILLE FL
32224-1865
US

IV. Provider business mailing address

4500 SAN PABLO RD S
JACKSONVILLE FL
32224-1865
US

V. Phone/Fax

Practice location:
  • Phone: 904-953-2000
  • Fax:
Mailing address:
  • Phone: 904-953-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036154382
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberME162378
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: