Provider Demographics
NPI:1588686877
Name:HAYES, DAPHNE T (ARNP)
Entity type:Individual
Prefix:
First Name:DAPHNE
Middle Name:T
Last Name:HAYES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19249
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32245-9249
Mailing Address - Country:US
Mailing Address - Phone:904-642-9100
Mailing Address - Fax:904-642-9108
Practice Address - Street 1:390 PARK ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-2342
Practice Address - Country:US
Practice Address - Phone:904-899-6300
Practice Address - Fax:904-899-6380
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLFL2667172363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL764148600Medicaid
FL162529600Medicaid
FL764148600Medicaid