Provider Demographics
NPI:1790882256
Name:JONES, DIANE M
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4445 RIVER TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-1110
Mailing Address - Country:US
Mailing Address - Phone:904-762-0005
Mailing Address - Fax:
Practice Address - Street 1:7749 NORMANDY BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-7657
Practice Address - Country:US
Practice Address - Phone:904-781-2509
Practice Address - Fax:904-781-2761
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS25714183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist