Most Relevant Information
Provider Data
| NPI Number: | 1003407248 |
| Provider Name: | DEANDRA DOMINIQUE DICKSON |
| Entity Type: | Individual |
| Taxonomy Code: | 376K00000X |
| Specialty: | Nurse's Aide |
| License Number: | 281051 |
Most Important Dates
| Enumeration Date: | 01/31/2021 |
| Last Updated: | 01/31/2021 |
Provider Practice Location
9145 13TH AVE
JACKSONVILLE
FL
32208
Practice Location Phone/Fax
| Phone: | 9047239713 |
| Fax: |
Provider Mailing Location
9145 13TH AVE
JACKSONVILLE
FL
32208
Provider Mailing Phone/Fax
| Phone: | 9047239713 |
| Fax: |