Individual
DR. TAVENNER TATHEN DIBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1600 SW ARCHER RD, GAINESVILLE, FL 32610-3003
(352) 273-9001
Mailing address
1600 SW ARCHER RD, GAINESVILLE, FL 32610-3003
(352) 273-9001
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
ME140590
FL
2080P0202X
Pediatric Cardiology Physician
ME140590
FL
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
ME140590
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123082700
—
FL
Enumeration date
05/23/2016
Last updated
08/08/2024
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