Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | APRN11007660 | FL |
N | 363LA2200X | Nurse Practitioner - Adult Health | APRN11007660 | FL |
NPI | 1003432576 |
---|---|
Provider Name | Miss Jessica Diehl |
First Address | Naples, FL 34101-8569 |
Second Address | Naples, FL 34109-0595 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2020 |
Last Update Date | 18/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
107241700 | (05) | FL |
9PSOV | BCBS (01) | FL |