Provider Demographics
NPI:1255923645
Name:JENKINS-KING, DIANE PATRICIA (RN CRRN)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:PATRICIA
Last Name:JENKINS-KING
Suffix:
Gender:F
Credentials:RN CRRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 NW 101ST DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-8030
Mailing Address - Country:US
Mailing Address - Phone:352-682-1577
Mailing Address - Fax:
Practice Address - Street 1:2708 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1316
Practice Address - Country:US
Practice Address - Phone:352-554-2170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-07
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2802612163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitation