Provider Demographics
NPI:1205174257
Name:ROXBOROUGH, DIANNE JEMELLE DUYA (NP)
Entity type:Individual
Prefix:
First Name:DIANNE JEMELLE
Middle Name:DUYA
Last Name:ROXBOROUGH
Suffix:
Gender:F
Credentials:NP
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 143205
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32614-3205
Mailing Address - Country:US
Mailing Address - Phone:323-327-5821
Mailing Address - Fax:
Practice Address - Street 1:3925 NW 43RD ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-4565
Practice Address - Country:US
Practice Address - Phone:352-614-0603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-26
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11005039363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily