Provider Demographics
NPI:1184633240
Name:PINO, MICHELE CATHERINE SR (MS, RD, LD)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:CATHERINE
Last Name:PINO
Suffix:SR
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 LEMHURST RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-3539
Mailing Address - Country:US
Mailing Address - Phone:850-505-6412
Mailing Address - Fax:850-505-6933
Practice Address - Street 1:6000 W. HWY 98
Practice Address - Street 2:MNT/CODE 11
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32512
Practice Address - Country:US
Practice Address - Phone:850-505-6417
Practice Address - Fax:850-505-6933
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNC 002985133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered