Healthcare Provider Details

I. General information

NPI: 1740936228
Provider Name (Legal Business Name): JEIMI DIEDRICH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JEIMI CABRAL

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 DOUGLAS AVE
ALTAMONTE SPRINGS FL
32714-3335
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 200
MIAMI FL
33126-3168
US

V. Phone/Fax

Practice location:
  • Phone: 407-788-8200
  • Fax: 407-788-3746
Mailing address:
  • Phone: 844-630-0700
  • Fax: 877-374-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11017892
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: