Provider Demographics
NPI:1346851250
Name:VELASQUEZ, AMBER NICOLE (RDN, LD)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:NICOLE
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13777 OLD CREEK CT
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-3121
Mailing Address - Country:US
Mailing Address - Phone:678-877-2064
Mailing Address - Fax:
Practice Address - Street 1:13777 OLD CREEK CT
Practice Address - Street 2:
Practice Address - City:PARRISH
Practice Address - State:FL
Practice Address - Zip Code:34219-3121
Practice Address - Country:US
Practice Address - Phone:678-877-2064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL86151204133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered