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General NPI Number Information
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NPI Number | 1831564210
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Entity Type | Individual
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Provider Name | JENNIFER ANN DIEU ARNP
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Gender | Female
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Dates
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Enumeration Date | 12/10/2015
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Last Update Date | 01/11/2022
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Provider Practice Location Address
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Address Line | 7780 CAMBRIDGE MANOR PL SUITE C
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City | FORT MYERS
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State | FL
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Zip | 33907-3656
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Country | US
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Telephone | 239-689-6130
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Fax | 216-896-9302
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Provider Business Mailing Address
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Address Line | 1207 BALTIMORE AVE
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City | WAYCROSS
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State | GA
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Zip | 31501-4228
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Country | US
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Telephone | 973-713-7322
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | ARNP9198060
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License Number State | FL
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