Provider Demographics
NPI:1295030138
Name:VINCENT, TAMI S (RD, LD/N)
Entity Type:Individual
Prefix:MRS
First Name:TAMI
Middle Name:S
Last Name:VINCENT
Suffix:
Gender:F
Credentials:RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14963 YORKSHIRE RUN DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7835
Mailing Address - Country:US
Mailing Address - Phone:407-382-0448
Mailing Address - Fax:
Practice Address - Street 1:14963 YORKSHIRE RUN DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7835
Practice Address - Country:US
Practice Address - Phone:407-382-0448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5511133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered