Provider Demographics
NPI:1457816993
Name:VINCENT, DADLANIE (CNA)
Entity Type:Individual
Prefix:
First Name:DADLANIE
Middle Name:
Last Name:VINCENT
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7507 BEACH BLVD APT 2404
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3077
Mailing Address - Country:US
Mailing Address - Phone:904-874-1234
Mailing Address - Fax:
Practice Address - Street 1:4110 SOUTHPOINT BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-0947
Practice Address - Country:US
Practice Address - Phone:904-874-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL263046376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide