Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 9203697 | FL |
NPI | 1003321308 |
---|---|
Provider Name | Diana Lynn Bridges |
First Address | Jacksonville, FL 32260-0643 |
Second Address | Orange Park, FL 32073-5148 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2017 |
Last Update Date | 08/12/2017 |