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General NPI Number Information
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NPI Number | 1992117519
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Entity Type | Individual
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Provider Name | JELINDA VANLORA DIMICK APRN
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Gender | Female
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Dates
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Enumeration Date | 06/02/2014
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 4968 WABASH PINE CT
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City | MILTON
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State | FL
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Zip | 32571-2768
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Country | US
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Telephone | 850-490-3849
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Fax |
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Provider Business Mailing Address
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Address Line | 120 CHIEFS WAY STE 1 PMB 207
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City | PENSACOLA
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State | FL
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Zip | 32507-1100
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Country | US
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Telephone | 850-490-3849
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 318229-31
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11040535
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License Number State | FL
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