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General NPI Number Information
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NPI Number | 1467167841
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Entity Type | Individual
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Provider Name | DIANA COLLETTE APRN
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Gender | Female
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Dates
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Enumeration Date | 01/19/2023
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Last Update Date | 01/19/2023
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Provider Practice Location Address
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Address Line | 4215 PLANTATION OAKS BLVD
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City | ORANGE PARK
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State | FL
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Zip | 32065-3641
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Country | US
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Telephone | 904-633-0820
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Fax |
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Provider Business Mailing Address
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Address Line | 78 SOLIS AVE
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City | SAINT JOHNS
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State | FL
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Zip | 32259-1256
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Country | US
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Telephone | 305-766-5348
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11020846
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License Number State | FL
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