Individual
DIANA MARIE PHELPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2080 CHILD ST, JACKSONVILLE, FL 32214-5005
(715) 330-9250
Mailing address
2080 CHILD ST, JACKSONVILLE, FL 32214-5005
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/08/2024
Last updated
07/01/2024
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