Provider Demographics
NPI:1386724193
Name:OPENBRIER, DIANA ROSE (PHD ARNP BC)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:ROSE
Last Name:OPENBRIER
Suffix:
Gender:F
Credentials:PHD ARNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:4495 ROOSEVELT BLVD
Mailing Address - Street 2:SUITE 316
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-3375
Mailing Address - Country:US
Mailing Address - Phone:904-387-6365
Mailing Address - Fax:
Practice Address - Street 1:MOOSEHAVEN
Practice Address - Street 2:1701 PARK AVE.
Practice Address - City:ORANG PARK
Practice Address - State:FL
Practice Address - Zip Code:32073
Practice Address - Country:US
Practice Address - Phone:904-278-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2974192363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner