Provider Demographics
NPI:1033796578
Name:VERO, AUDREY LYNN (MS, RD)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:LYNN
Last Name:VERO
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 BAYVIEW PKWY
Mailing Address - Street 2:
Mailing Address - City:NOKOMIS
Mailing Address - State:FL
Mailing Address - Zip Code:34275-3951
Mailing Address - Country:US
Mailing Address - Phone:352-425-3670
Mailing Address - Fax:
Practice Address - Street 1:415 BAYVIEW PKWY
Practice Address - Street 2:
Practice Address - City:NOKOMIS
Practice Address - State:FL
Practice Address - Zip Code:34275-3951
Practice Address - Country:US
Practice Address - Phone:352-425-3670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered