Provider Demographics
NPI:1922156470
Name:DIETRICH, ANN JOAN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:JOAN
Last Name:DIETRICH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 SE INDIAN ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-5688
Mailing Address - Country:US
Mailing Address - Phone:772-403-4500
Mailing Address - Fax:772-403-1400
Practice Address - Street 1:1201 SE INDIAN ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-5688
Practice Address - Country:US
Practice Address - Phone:772-403-4500
Practice Address - Fax:772-403-1400
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN1672812363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily