Provider Demographics
NPI:1831564210
Name:DIEU, JENNIFER ANN (ARNP)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANN
Last Name:DIEU
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-4228
Mailing Address - Country:US
Mailing Address - Phone:973-713-7322
Mailing Address - Fax:
Practice Address - Street 1:7780 CAMBRIDGE MANOR PL
Practice Address - Street 2:SUITE C
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3656
Practice Address - Country:US
Practice Address - Phone:239-689-6130
Practice Address - Fax:216-896-9302
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9198060363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner