Provider Demographics
NPI:1457726085
Name:DIBENEDETTO, PAULA JEAN (ARNP)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:JEAN
Last Name:DIBENEDETTO
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 1:1889 PROFESSIONAL PARK CIR STE 30
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4511
Mailing Address - Country:US
Mailing Address - Phone:850-325-4900
Mailing Address - Fax:850-325-7080
Practice Address - Street 1:1889 PROFESSIONAL PARK CIR STE 30
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4511
Practice Address - Country:US
Practice Address - Phone:850-325-4900
Practice Address - Fax:850-325-7080
Is Sole Proprietor?:No
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9218183363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology