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NPI Code Detail

MEDICARE: DIVYAMOL JOSEPH

MEDICARE: DIVYAMOL JOSEPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LN0000XNeonatal Nurse Practitioner1041208TX

General Provider Information

NPI Number : 1538090519
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIVYAMOL JOSEPH
Provider Business Mailing Address
First Line : 5373 ARCHWAY DR
Second Line :
City : GARLAND
State : TX
Zip : 75040-8769
Country : US
Telephone Number : 470-418-0310
Fax Number :
Provider Business Practice Location Address
First Line : 807 CHILDRENS WAY
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-8426
Country : US
Telephone Number : 904-697-3600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2026
Last Update Date : 05/27/2026

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Directions to “ DIVYAMOL JOSEPH ” Practice Location

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