Provider Demographics
NPI:1336395755
Name:SARGENT, DANA RENEE (LPN)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:RENEE
Last Name:SARGENT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32325 GRAND PARKE BLVD
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-1131
Mailing Address - Country:US
Mailing Address - Phone:904-261-0429
Mailing Address - Fax:904-733-2650
Practice Address - Street 1:32325 GRAND PARKE BLVD
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-1131
Practice Address - Country:US
Practice Address - Phone:904-261-0429
Practice Address - Fax:904-733-2650
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5167063164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCBS 693 327 196Medicaid