Provider Demographics
NPI:1467828962
Name:DIBELLO, REGINA (ARNP)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:DIBELLO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38135 MARKET SQ
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7505
Mailing Address - Country:US
Mailing Address - Phone:813-528-4975
Mailing Address - Fax:
Practice Address - Street 1:12500 N DALE MABRY HWY
Practice Address - Street 2:STE D
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2809
Practice Address - Country:US
Practice Address - Phone:813-388-6855
Practice Address - Fax:813-355-5894
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9323015363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016815200Medicaid
FL016815200Medicaid
FLIJ777Y-PASCOMedicare PIN