Healthcare Provider Details

I. General information

NPI: 1801476999
Provider Name (Legal Business Name): JESSICA ELIZABETH DIBIANCO MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA ELIZABETH BORCHERT

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-8632
US

IV. Provider business mailing address

PO BOX 100214
GAINESVILLE FL
32610-0214
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-9400
  • Fax:
Mailing address:
  • Phone: 352-273-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704360664
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11019535
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: