Provider Demographics
NPI:1457055725
Name:DHAKHWA, SUJEETA (APRN, FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:SUJEETA
Middle Name:
Last Name:DHAKHWA
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 HERON LANDING RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-7026
Mailing Address - Country:US
Mailing Address - Phone:904-982-5965
Mailing Address - Fax:
Practice Address - Street 1:5200 BELFORT RD STE 420
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6040
Practice Address - Country:US
Practice Address - Phone:904-281-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11025549363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily