Healthcare Provider Details

I. General information

NPI: 1467782813
Provider Name (Legal Business Name): JILL MARIE DIESMAN AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2010
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2184 GULF GATE DR
SARASOTA FL
34231-4813
US

IV. Provider business mailing address

2184 GULF GATE DR
SARASOTA FL
34231-4813
US

V. Phone/Fax

Practice location:
  • Phone: 941-922-5094
  • Fax: 941-927-2424
Mailing address:
  • Phone: 941-922-5094
  • Fax: 941-927-2424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAY2084
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY2084
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: