Provider Demographics
NPI:1235297763
Name:UPTON, KARLINE (MS RD LD CNSD)
Entity Type:Individual
Prefix:
First Name:KARLINE
Middle Name:
Last Name:UPTON
Suffix:
Gender:F
Credentials:MS RD LD CNSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1442 ROLLING RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-2825
Mailing Address - Country:US
Mailing Address - Phone:727-786-8279
Mailing Address - Fax:
Practice Address - Street 1:4710 EISENHOWER BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-6335
Practice Address - Country:US
Practice Address - Phone:813-886-5866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND1867133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered