Basic Information
| Provider Information | |||||||||
| NPI: | 1891381133 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUDNIK | ||||||||
| FirstName: | DIANA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 1ST ST S APT 2H | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322506657 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9044777076 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3625 UNIVERSITY BLVD S | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322164207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9047026111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2020 | ||||||||
| LastUpdateDate: | 03/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WM0705X | 9452553 | FL | N | Nursing Service Providers | Registered Nurse | Medical-Surgical | 363L00000X | 11012166 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.