Individual
STEPHANIE DIEFFENTHALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8787 BRYAN DAIRY RD STE 250, LARGO, FL 33777-1259
(727) 391-6296
(813) 635-7940
Mailing address
8787 BRYAN DAIRY RD STE 250, LARGO, FL 33777-1259
(727) 391-6296
(813) 635-7940
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9112980
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116213700
—
FL
Enumeration date
11/08/2019
Last updated
04/03/2023
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