Healthcare Provider Details

I. General information

NPI: 1548643109
Provider Name (Legal Business Name): CAITLIN C DIETRICH DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2015
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1879 NIGHTINGALE LN STE B1
TAVARES FL
32778-4363
US

IV. Provider business mailing address

15815 SHADDOCK DR STE 130
WINTER GARDEN FL
34787-5773
US

V. Phone/Fax

Practice location:
  • Phone: 352-744-3220
  • Fax: 407-671-4155
Mailing address:
  • Phone: 407-605-2321
  • Fax: 407-671-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO4016
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO4016
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: