Healthcare Provider Details

I. General information

NPI: 1831564210
Provider Name (Legal Business Name): JENNIFER ANN DIEU ARNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2015
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 BALTIMORE AVE
WAYCROSS GA
31501-4228
US

IV. Provider business mailing address

1203 BALTIMORE AVE
WAYCROSS GA
31501-4228
US

V. Phone/Fax

Practice location:
  • Phone: 973-713-6819
  • Fax: 855-243-0002
Mailing address:
  • Phone: 973-713-7322
  • Fax: 855-243-0002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberARNP9198060
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: