Provider Demographics
NPI:1861699225
Name:PRESTON, DANA YVONNE (PHD, APRN, - CS)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:YVONNE
Last Name:PRESTON
Suffix:
Gender:F
Credentials:PHD, APRN, - CS
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 746638
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6638
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:5491 DOLPHIN POINT BLVD STE 3110
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-3221
Practice Address - Country:US
Practice Address - Phone:904-744-5244
Practice Address - Fax:904-390-7474
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN1145002363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY3178QMedicare PIN
FLY3178RMedicare PIN