1588686877 NPI number — DAPHNE T HAYES ARNP

Table of content: DAPHNE T HAYES ARNP (NPI 1588686877)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588686877 NPI number — DAPHNE T HAYES ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAYES
Provider First Name:
DAPHNE
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
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:
1588686877
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 19249
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32245-9249
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-642-9100
Provider Business Mailing Address Fax Number:
904-642-9108

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
390 PARK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32204-2342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-899-6300
Provider Business Practice Location Address Fax Number:
904-899-6380
Provider Enumeration Date:
07/24/2006

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: FL2667172 , 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)

  • Identifier: 764148600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 162529600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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