Healthcare Provider Details

I. General information

NPI: 1821402389
Provider Name (Legal Business Name): JAMIE MICHELLE DIPRIMO MSN, ARNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 EPIC BLVD STE 100
ST AUGUSTINE FL
32086-6603
US

IV. Provider business mailing address

30 EPIC BLVD STE 100
ST AUGUSTINE FL
32086-6603
US

V. Phone/Fax

Practice location:
  • Phone: 904-217-3881
  • Fax: 904-342-2368
Mailing address:
  • Phone: 904-217-3881
  • Fax: 904-342-2368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberC-APN.0002407-C-NP
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9262982
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: