Provider Demographics
NPI:1396984712
Name:DIBIASIO, BETH ANNE (MT(ASCP))
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ANNE
Last Name:DIBIASIO
Suffix:
Gender:F
Credentials:MT(ASCP)
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:ANNE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT(ASCP)
Mailing Address - Street 1:16310 SW 60TH PL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34481-5318
Mailing Address - Country:US
Mailing Address - Phone:352-209-6165
Mailing Address - Fax:
Practice Address - Street 1:4800 SW 35TH DR
Practice Address - Street 2:CORE LAB, RM 1106
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608
Practice Address - Country:US
Practice Address - Phone:352-265-0680
Practice Address - Fax:352-265-9971
Is Sole Proprietor?:No
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSU26859246QL0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QL0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management