Provider Demographics
NPI:1588755045
Name:JONES, ORETHA DIANE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:ORETHA
Middle Name:DIANE
Last Name:JONES
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 1:1130 SCHWALL RD
Mailing Address - Street 2:
Mailing Address - City:HAVANA
Mailing Address - State:FL
Mailing Address - Zip Code:32333-6162
Mailing Address - Country:US
Mailing Address - Phone:850-408-1293
Mailing Address - Fax:850-663-2306
Practice Address - Street 1:1130 SCHWALL RD
Practice Address - Street 2:
Practice Address - City:HAVANA
Practice Address - State:FL
Practice Address - Zip Code:32333-6162
Practice Address - Country:US
Practice Address - Phone:850-694-9864
Practice Address - Fax:850-270-2452
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 3298622363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307930900Medicaid
FLDL928ZOtherMEDICARE