Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | MW152 | FL |
NPI | 1063534709 |
---|---|
Provider Name | Tammy Ann Dieffenbach |
First Address | Stuart, FL 34994-2925 |
Second Address | Stuart, FL 34994-2925 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2007 |
Last Update Date | 07/11/2017 |