Provider Demographics
NPI:1265446108
Name:ROSENBERG, GINA P (RD)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:P
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:782 NOCATEE VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-0280
Mailing Address - Country:US
Mailing Address - Phone:954-829-8822
Mailing Address - Fax:
Practice Address - Street 1:782 NOCATEE VILLAGE DR
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-0280
Practice Address - Country:US
Practice Address - Phone:954-829-8822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4387133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered