Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jeremy Daniel Dibiasio

Individual provider Family Nurse Practitioner · NPI 1114533783

Jeremy Daniel Dibiasio is a Nurse Practitioner in Warwick, Rhode Island. Qualified in 2020, 6 years ago. Practices with Lifespan Physician Group Inc, a 1,125-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Rhode Island.

Years since qualifying
6
Licensed in
RI
In the registry since
2020
Specialties on file
2
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Practice location Address checks out

17 Airport Rd
Warwick, RI 02889-1001
Phone: (401) 606-2520
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1 Warren Way, Providence, RI 02905-5000 — (401) 444-0530

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X
Family Nurse Practitioner Taxonomy 363LF0000X · Licence APRN02742 (RI)

Record details

NPI number1114533783
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedSeptember 19, 2020
Last updated in NPPESSeptember 9, 2021
Certification dateJune 7, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Lifespan Physician Group Inc — 1125 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Warwick