Provider Demographics
NPI:1225375611
Name:RICKETTS-CAMERON, NNEKA C (RD)
Entity Type:Individual
Prefix:MRS
First Name:NNEKA
Middle Name:C
Last Name:RICKETTS-CAMERON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:NNEKA
Other - Middle Name:C
Other - Last Name:RICKETTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:83 W COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1101
Mailing Address - Country:US
Mailing Address - Phone:321-841-3121
Mailing Address - Fax:321-841-2170
Practice Address - Street 1:83 W COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1101
Practice Address - Country:US
Practice Address - Phone:321-841-3121
Practice Address - Fax:321-841-2170
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4528133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered