Provider Demographics
NPI:1679743967
Name:FAULKNER, DIANE
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9564 GLENN ABBEY WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6491
Mailing Address - Country:US
Mailing Address - Phone:904-233-3331
Mailing Address - Fax:866-654-6692
Practice Address - Street 1:9564 GLENN ABBEY WAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6491
Practice Address - Country:US
Practice Address - Phone:904-233-3331
Practice Address - Fax:866-654-6692
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program