Provider Demographics
NPI:1487270971
Name:DYCKMAN, JEANNE MARIE (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:MARIE
Last Name:DYCKMAN
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12471 MCGREGOR BLVD APT 9
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3155
Mailing Address - Country:US
Mailing Address - Phone:239-213-8610
Mailing Address - Fax:
Practice Address - Street 1:12471 MCGREGOR BLVD APT 9
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3155
Practice Address - Country:US
Practice Address - Phone:239-213-8610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9272229163W00000X
FLAPRN11008805363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse