1386724193 NPI number — DR. DIANA ROSE OPENBRIER PHD ARNP BC

Table of content: DR. DIANA ROSE OPENBRIER PHD ARNP BC (NPI 1386724193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386724193 NPI number — DR. DIANA ROSE OPENBRIER PHD ARNP BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OPENBRIER
Provider First Name:
DIANA
Provider Middle Name:
ROSE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD ARNP BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386724193
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4495 ROOSEVELT BLVD
Provider Second Line Business Mailing Address:
SUITE 316
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32210-3375
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-387-6365
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MOOSEHAVEN
Provider Second Line Business Practice Location Address:
1701 PARK AVE.
Provider Business Practice Location Address City Name:
ORANG PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-278-1200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  ARNP2974192 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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