Diem Wiesen

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

11003120 Issued in FL

Practice address

1619 Broad Winged Hawk Dr
Ruskin, FL 33570-4955

Phone

(440) 590-3071

NPI assigned

Sep 4, 2019

Last updated

Sep 4, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1567555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567555200000",
    "number": "1720637556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1619 BROAD WINGED HAWK DR",
            "city": "RUSKIN",
            "state": "FL",
            "postal_code": "335704955",
            "telephone_number": "440-590-3071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1619 BROAD WINGED HAWK DR",
            "city": "RUSKIN",
            "state": "FL",
            "postal_code": "335704955",
            "telephone_number": "440-590-3071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIESEN",
        "first_name": "DIEM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-04",
        "last_updated": "2019-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11003120",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "FL",
            "license": "9508713",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mallicent Wesley
• West Coast Mobile Eye Care, Inc
• Chantanae Janequa White
• Whitney J Luster PA
• Cecilia M Wickert
• Lakisha F Williams-Noukhal, APRN
• Shanequa M Williams
• Clarice Wills
• Wilson and Family LLC
• Michael Wimberly

• Family Nurse Practitioner in Ruskin, FL
• Providers in Ruskin, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.