Provider Demographics
NPI:1023540580
Name:SANJINES, DIANE (ARNP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:SANJINES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WHETSTONE PL STE 211
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5775
Mailing Address - Country:US
Mailing Address - Phone:904-342-7648
Mailing Address - Fax:
Practice Address - Street 1:100 WHETSTONE PL STE 211
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5775
Practice Address - Country:US
Practice Address - Phone:904-342-7648
Practice Address - Fax:904-342-8567
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9264502363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics