Basic Information
| Provider Information | |||||||||
| NPI: | 1427669423 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TOMPKINS | ||||||||
| FirstName: | DIANNA | ||||||||
| MiddleName: | LOUISE | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2974 LANTANA LAKES DR E | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322461816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9046314016 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11820 BEACH BLVD | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322466670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9046429100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2020 | ||||||||
| LastUpdateDate: | 02/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 11012464 | FL | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 163WP0808X | 9430895 | FL | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 363LP0808X | APRN11012464 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.