Provider Demographics
NPI:1285216200
Name:DIMAIN, MICHAELA MAYOL (APRN)
Entity Type:Individual
Prefix:MS
First Name:MICHAELA
Middle Name:MAYOL
Last Name:DIMAIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7503 DEVONDALE WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4832
Mailing Address - Country:US
Mailing Address - Phone:904-554-3092
Mailing Address - Fax:
Practice Address - Street 1:330 A1A N STE 321
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-1826
Practice Address - Country:US
Practice Address - Phone:904-280-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11008391363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily