MEDICARE: MRS. DRINA GERALDINE PORTMAN DNP, APRN-BC

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
1	363LA2200X	Adult Health Nurse Practitioner	APRN2621802	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	APRN2621802	OTHER	FL	FLORIDA BOARD OF NURSING
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659362424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DRINA GERALDINE PORTMAN DNP, APRN-BC

Provider Business Mailing Address
First Line	:	7406 FULLERTON ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-3552
Country	:	US
Telephone Number	:	305-336-2711
Fax Number	:	954-920-9855

Provider Business Practice Location Address
First Line	:	7406 FULLERTON ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-3552
Country	:	US
Telephone Number	:	305-336-2711
Fax Number	:	954-920-9855

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	06/22/2020

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