Individual
MS. JENNIFER LEE DIANA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8093 NORMANDY BLVD, JACKSONVILLE, FL 32221-6646
(904) 633-0640
(904) 633-0641
Mailing address
2675 WINKLER AVE FL 2, FORT MYERS, FL 33901-9342
(877) 856-3774
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9101519
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2909626-00
—
FL
01
—
OA835
MEDICARE
FL
Enumeration date
03/04/2006
Last updated
10/04/2021
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