Provider Demographics
NPI:1073763264
Name:MASSON, JENNIFER P (RD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:P
Last Name:MASSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:MASSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:2409 HUNTINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-5235
Mailing Address - Country:US
Mailing Address - Phone:727-455-9066
Mailing Address - Fax:
Practice Address - Street 1:2409 HUNTINGTON BLVD
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-5235
Practice Address - Country:US
Practice Address - Phone:727-455-9066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4248133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered