Provider Demographics
NPI:1225081904
Name:TIEGEN, VIVIAN ELLEN (RDN,LDN, CDE)
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:ELLEN
Last Name:TIEGEN
Suffix:
Gender:F
Credentials:RDN,LDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 MILITARY TRL
Mailing Address - Street 2:SUITE 205
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-4834
Mailing Address - Country:US
Mailing Address - Phone:561-624-9744
Mailing Address - Fax:561-623-0845
Practice Address - Street 1:4601 MILITARY TRL
Practice Address - Street 2:SUITE 205
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4834
Practice Address - Country:US
Practice Address - Phone:561-624-9744
Practice Address - Fax:561-623-0845
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND2151133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered