Individual
HAYLEE NICOLE DIETRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
14952 PINES BLVD, PEMBROKE PINES, FL 33027-1213
(813) 943-9608
Mailing address
3635 NE 1ST AVE APT 904, MIAMI, FL 33137-3650
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9114069
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1181596
NCCPA
—
01
—
PA9114069
FLORIDA PHYSICIAN ASSISTANT LICENSE
FL
Enumeration date
11/19/2021
Last updated
11/19/2021
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