Provider Demographics
NPI:1114412129
Name:HAGENBURGER, TIMAREE (RDN, MPH, EP-C)
Entity Type:Individual
Prefix:MRS
First Name:TIMAREE
Middle Name:
Last Name:HAGENBURGER
Suffix:
Gender:F
Credentials:RDN, MPH, EP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 HAZELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-4714
Mailing Address - Country:US
Mailing Address - Phone:209-747-2195
Mailing Address - Fax:
Practice Address - Street 1:550 HAZELWOOD DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4714
Practice Address - Country:US
Practice Address - Phone:209-747-2195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
865203133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
865203OtherCOMMISSION ON DIETETIC REGISTRATION