Provider Demographics
NPI:1285518480
Name:DIEM, REBECCA HELENE
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:HELENE
Last Name:DIEM
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11025 VIGNETTE ALY
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-1762
Mailing Address - Country:US
Mailing Address - Phone:321-527-0838
Mailing Address - Fax:
Practice Address - Street 1:11025 VIGNETTE ALY
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-1762
Practice Address - Country:US
Practice Address - Phone:321-527-0838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-01
Last Update Date:2025-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11041319363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily