Provider Demographics
NPI:1194381954
Name:MCCANN, JESSICA (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MCCANN
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1727 NEW HAMPSHIRE AVE NE
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-3347
Mailing Address - Country:US
Mailing Address - Phone:609-605-8881
Mailing Address - Fax:
Practice Address - Street 1:1727 NEW HAMPSHIRE AVE NE
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-3347
Practice Address - Country:US
Practice Address - Phone:609-605-8881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL86086131133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered