Provider Demographics
NPI:1003434341
Name:DIDIER, PATRICIA DIANNE (NP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:DIANNE
Last Name:DIDIER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 UNIVERSITY BLVD S STE 206
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-2753
Mailing Address - Country:US
Mailing Address - Phone:904-886-0361
Mailing Address - Fax:
Practice Address - Street 1:3101 UNIVERSITY BLVD S STE 206
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-2753
Practice Address - Country:US
Practice Address - Phone:904-886-0361
Practice Address - Fax:904-886-0382
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN273785363LP0808X
FL11009911363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health