Healthcare Provider Details

I. General information

NPI: 1396519369
Provider Name (Legal Business Name): ROBERT DYKES APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ROBERT EUGENE DYKES III

II. Dates (important events)

Enumeration Date: 11/10/2023
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 BELFORT RD
JACKSONVILLE FL
32216-1431
US

IV. Provider business mailing address

4201 BELFORT RD
JACKSONVILLE FL
32216-1431
US

V. Phone/Fax

Practice location:
  • Phone: 904-308-8435
  • Fax:
Mailing address:
  • Phone: 904-308-8435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11029650
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: