Provider Demographics
NPI:1093398505
Name:MEZA JIMENEZ, JENNIFFER ALEXANDRA (LD/N, CLC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFFER
Middle Name:ALEXANDRA
Last Name:MEZA JIMENEZ
Suffix:
Gender:F
Credentials:LD/N, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 45TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2361
Mailing Address - Country:US
Mailing Address - Phone:561-506-5693
Mailing Address - Fax:
Practice Address - Street 1:1150 45TH ST
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2361
Practice Address - Country:US
Practice Address - Phone:561-506-5693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2022-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL324440174N00000X, 174N00000X
FLND9639133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist