Healthcare Provider Details

I. General information

NPI: 1861657587
Provider Name (Legal Business Name): JACINDA MARIE DIPLACIDO CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 PEACH ST
ERIE PA
16501-2109
US

IV. Provider business mailing address

137 E 35TH ST
ERIE PA
16504-1513
US

V. Phone/Fax

Practice location:
  • Phone: 814-453-4718
  • Fax: 814-455-7463
Mailing address:
  • Phone: 814-451-0761
  • Fax: 814-455-7463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF0508067
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: