Healthcare Provider Details

I. General information

NPI: 1932115383
Provider Name (Legal Business Name): DARLENE M VONTOBEL A.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DARLENE MARIE KRZYZANIAK A.R.N.P.

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 08/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 SOUTHSIDE BLVD
JACKSONVILLE FL
32216-1930
US

IV. Provider business mailing address

PO BOX 850001
ORLANDO FL
32885-0192
US

V. Phone/Fax

Practice location:
  • Phone: 904-724-3083
  • Fax: 904-727-9103
Mailing address:
  • Phone: 904-282-6331
  • Fax: 904-282-4117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP1585122
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: