Provider Demographics
NPI:1013374131
Name:BOYD, GLORIANNE (RD,LD/N)
Entity Type:Individual
Prefix:MRS
First Name:GLORIANNE
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:RD,LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 UNIVERSITY BLVD S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4207
Mailing Address - Country:US
Mailing Address - Phone:904-399-6313
Mailing Address - Fax:904-391-3215
Practice Address - Street 1:3625 UNIVERSITY BLVD S
Practice Address - Street 2:BARIATRIC DEPARTMENT
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4207
Practice Address - Country:US
Practice Address - Phone:904-399-6313
Practice Address - Fax:904-391-3215
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND6014133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered