Basic Information
| Provider Information | |||||||||
| NPI: | 1639392699 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADAIR | ||||||||
| FirstName: | DOROTHY | ||||||||
| MiddleName: | DEAN GENTILE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 841 PRUDENTIAL DR | ||||||||
| Address2: | 10TH FLOOR | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322078329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043985404 | ||||||||
| FaxNumber: | 9043915545 | ||||||||
| Practice Location | |||||||||
| Address1: | 841 PRUDENTIAL DR | ||||||||
| Address2: | 10TH FLOOR | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322078329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043985404 | ||||||||
| FaxNumber: | 9043915545 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2007 | ||||||||
| LastUpdateDate: | 09/19/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | ARNP1225292 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363L00000X | ARNP1225292 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 002411200 | 05 | FL | MEDICAID |