Provider Demographics
NPI:1306862958
Name:DIDI, REBECCA ANN (ARNP)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ANN
Last Name:DIDI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:RENAULT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:705 WELLS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2982
Mailing Address - Country:US
Mailing Address - Phone:905-282-6331
Mailing Address - Fax:904-282-4117
Practice Address - Street 1:7855 ARGYLE FOREST BLVD
Practice Address - Street 2:SUITE 601
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-5596
Practice Address - Country:US
Practice Address - Phone:904-778-3389
Practice Address - Fax:904-778-3395
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2842542363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307466800Medicaid
FL307466800Medicaid
FLE8071ZMedicare PIN