Provider Demographics
NPI:1154303030
Name:DUFFY, KAREN ELAINE (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:ELAINE
Last Name:DUFFY
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 NATURE WALK PKWY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-5073
Mailing Address - Country:US
Mailing Address - Phone:904-599-7177
Mailing Address - Fax:
Practice Address - Street 1:111 NATURE WALK PKWY
Practice Address - Street 2:SUITE 106
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-5073
Practice Address - Country:US
Practice Address - Phone:904-599-7177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND2761133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP54186Medicare UPIN
FLE7118ZMedicare ID - Type Unspecified