Provider Demographics
NPI:1376609081
Name:LEONBERG, KRISTIN ELIZABETH (RD, LDN)
Entity Type:Individual
Prefix:MISS
First Name:KRISTIN
Middle Name:ELIZABETH
Last Name:LEONBERG
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:MISS
Other - First Name:KRISTIN
Other - Middle Name:E
Other - Last Name:LEONBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:104 S PRIMROSE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-6335
Mailing Address - Country:US
Mailing Address - Phone:724-910-7440
Mailing Address - Fax:
Practice Address - Street 1:802 N JOHN YOUNG PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4912
Practice Address - Country:US
Practice Address - Phone:407-847-4423
Practice Address - Fax:407-847-5973
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4559133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered