Provider Demographics
NPI:1902614456
Name:DIBBS, KATARZYNA
Entity type:Individual
Prefix:
First Name:KATARZYNA
Middle Name:
Last Name:DIBBS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3853 NORTHDALE BLVD # 330
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1861
Mailing Address - Country:US
Mailing Address - Phone:813-500-7183
Mailing Address - Fax:
Practice Address - Street 1:3750 GUNN HWY STE 306
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-8915
Practice Address - Country:US
Practice Address - Phone:813-500-7183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11036800363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty