Provider Demographics
NPI:1306856232
Name:DAMIANI, JAMES WILSON (RN)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WILSON
Last Name:DAMIANI
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:110 BONITA RD
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5706
Mailing Address - Country:US
Mailing Address - Phone:904-794-0038
Mailing Address - Fax:
Practice Address - Street 1:165 SOUTHPARK BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-4101
Practice Address - Country:US
Practice Address - Phone:904-824-7597
Practice Address - Fax:904-824-7598
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2040952163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN2040952OtherREGISTERED NURSE