Healthcare Provider Details

I. General information

NPI: 1366827925
Provider Name (Legal Business Name): DAWN J DIAZ ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DAWN J TERRERO ARNP

II. Dates (important events)

Enumeration Date: 07/24/2015
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

463832 STATE ROAD 200
YULEE FL
32097-3638
US

IV. Provider business mailing address

PO BOX 746638
ATLANTA GA
30374-6638
US

V. Phone/Fax

Practice location:
  • Phone: 904-225-2311
  • Fax: 904-390-7467
Mailing address:
  • Phone: 904-202-2092
  • Fax: 904-376-4075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9282622
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: