Healthcare Provider Details

I. General information

NPI: 1154142149
Provider Name (Legal Business Name): GINA MARIE DIBUONO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5323 4TH AVENUE CIR E
BRADENTON FL
34208-5623
US

IV. Provider business mailing address

3322 SW 2ND LN
CAPE CORAL FL
33991-1054
US

V. Phone/Fax

Practice location:
  • Phone: 941-745-5115
  • Fax:
Mailing address:
  • Phone: 239-220-4207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: