Healthcare Provider Details

I. General information

NPI: 1801474838
Provider Name (Legal Business Name): RACHEL DYKES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 PARK AVE
ORANGE PARK FL
32073-4120
US

IV. Provider business mailing address

906 PARK AVE
ORANGE PARK FL
32073-4120
US

V. Phone/Fax

Practice location:
  • Phone: 904-541-0315
  • Fax: 904-541-0316
Mailing address:
  • Phone: 904-541-0315
  • Fax: 904-541-0316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberOS22342
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: