Healthcare Provider Details

I. General information

NPI: 1528984051
Provider Name (Legal Business Name): VIVIAN DEDMON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30000 COUNTY LINE RD
WESLEY CHAPEL FL
33543-6707
US

IV. Provider business mailing address

701 FAYETTE PL
LUTZ FL
33549-7639
US

V. Phone/Fax

Practice location:
  • Phone: 813-907-8430
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11046386
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: