Healthcare Provider Details

I. General information

NPI: 1346847662
Provider Name (Legal Business Name): JESIKA DIETSCH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11760 SW 40TH ST STE 518
MIAMI FL
33175-8100
US

IV. Provider business mailing address

11760 SW 40TH ST STE 518
MIAMI FL
33175-8100
US

V. Phone/Fax

Practice location:
  • Phone: 305-553-2888
  • Fax:
Mailing address:
  • Phone: 305-553-2888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11009399
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: