Provider Demographics
NPI:1205103900
Name:DORCE, DADILINE (MD, APRN)
Entity type:Individual
Prefix:MS
First Name:DADILINE
Middle Name:
Last Name:DORCE
Suffix:
Gender:F
Credentials:MD, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 57185
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32241-7185
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4411 SUNBEAM RD UNIT 57185
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32241-8327
Practice Address - Country:US
Practice Address - Phone:904-297-8291
Practice Address - Fax:904-332-0414
Is Sole Proprietor?:No
Enumeration Date:2011-11-23
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHSE32609208D00000X
FLARNP9251268363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1205103900Medicaid
SCNP3232Medicaid
NCNCN653DMedicare PIN
NCNCN653AMedicare PIN
NCNCN653BMedicare PIN
SCNP3232Medicaid