Provider Demographics
NPI:1932115383
Name:VONTOBEL, DARLENE M (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:DARLENE
Middle Name:M
Last Name:VONTOBEL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:DARLENE
Other - Middle Name:MARIE
Other - Last Name:KRZYZANIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 850001
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32885-0192
Mailing Address - Country:US
Mailing Address - Phone:904-282-6331
Mailing Address - Fax:904-282-4117
Practice Address - Street 1:1906 SOUTHSIDE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1930
Practice Address - Country:US
Practice Address - Phone:904-724-3083
Practice Address - Fax:904-727-9103
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1585122363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304035600Medicaid
FLY3291ZMedicare PIN
FL304035600Medicaid