Provider Demographics
NPI:1164728010
Name:FEDOR, DINA MARIA (ARNP)
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:MARIA
Last Name:FEDOR
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:DINA
Other - Middle Name:
Other - Last Name:WARN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:6841 BLANDING BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-4418
Mailing Address - Country:US
Mailing Address - Phone:904-862-2175
Mailing Address - Fax:904-862-2330
Practice Address - Street 1:6841 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-4418
Practice Address - Country:US
Practice Address - Phone:904-862-2175
Practice Address - Fax:904-862-2330
Is Sole Proprietor?:No
Enumeration Date:2011-02-09
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9325745363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGM851UMedicare PIN