Provider Demographics
NPI:1508054388
Name:DIANA R TWIGGS MD
Entity Type:Organization
Organization Name:DIANA R TWIGGS MD
Other - Org Name:AMELIA ISLAND FAMILY MEDICINE PLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:R
Authorized Official - Last Name:TWIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-261-0922
Mailing Address - Street 1:1888 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-3054
Mailing Address - Country:US
Mailing Address - Phone:904-261-0922
Mailing Address - Fax:
Practice Address - Street 1:1888 S 14TH ST
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-3054
Practice Address - Country:US
Practice Address - Phone:904-261-0922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78633207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8740Medicare PIN
FLDD8165Medicare PIN