Individual
DIANE MARIE HEATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
10475 CENTURION PKWY N, SUITE 220, JACKSONVILLE, FL 32256-5003
(904) 634-0640
(904) 634-0203
Mailing address
6500 BOWDEN RD, SUITE 103, JACKSONVILLE, FL 32216-8070
(904) 634-0640
(904) 634-0203
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9101440
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041723183
CHAMPUS
FL
01
—
970017164
RAILROAD
FL
Enumeration date
11/05/2005
Last updated
07/26/2016
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