1992117519 NPI number — MISS JELINDA VANLORA DIMICK APRN

Table of content: MISS JELINDA VANLORA DIMICK APRN (NPI 1992117519)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992117519 NPI number — MISS JELINDA VANLORA DIMICK APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIMICK
Provider First Name:
JELINDA
Provider Middle Name:
VANLORA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PIMENTEL
Provider Other First Name:
JELINDA
Provider Other Middle Name:
VANLORA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992117519
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 CHIEFS WAY STE 1 PMB 207
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENSACOLA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32507-1100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-490-3849
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4968 WABASH PINE CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32571-2768
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-490-3849
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/02/2014

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: 164W00000X , with the licence number:  318229-31 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 11040535 , 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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