Provider Demographics
NPI:1285330944
Name:DIKO, ANNETTE
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:DIKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 GEORGE MILLER RD
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32145-4416
Mailing Address - Country:US
Mailing Address - Phone:702-526-4051
Mailing Address - Fax:
Practice Address - Street 1:201 GEORGE MILLER RD
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:FL
Practice Address - Zip Code:32145-4416
Practice Address - Country:US
Practice Address - Phone:702-526-4051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA74380OtherMASSAGE LICENSE