Provider Demographics
NPI:1386300309
Name:DIETERLE, JOSIE LEE ANN
Entity type:Individual
Prefix:
First Name:JOSIE
Middle Name:LEE ANN
Last Name:DIETERLE
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 1:7521 CUMBER DR
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-2428
Mailing Address - Country:US
Mailing Address - Phone:727-218-0350
Mailing Address - Fax:727-232-2693
Practice Address - Street 1:7521 CUMBER DR
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-2428
Practice Address - Country:US
Practice Address - Phone:727-218-0350
Practice Address - Fax:727-232-2693
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-14
Last Update Date:2021-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health