Provider Demographics
NPI:1003491002
Name:PARKER, JENNIFER MARIE ROSE (RDN, CSR, LDN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE ROSE
Last Name:PARKER
Suffix:
Gender:F
Credentials:RDN, CSR, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E UNIVERSITY AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-3460
Mailing Address - Country:US
Mailing Address - Phone:352-448-1260
Mailing Address - Fax:352-451-4186
Practice Address - Street 1:300 E UNIVERSITY AVE STE 210
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-3460
Practice Address - Country:US
Practice Address - Phone:352-448-1260
Practice Address - Fax:352-451-4186
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5837133V00000X, 133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered