Provider Demographics
NPI:1396021390
Name:SCHULTZ, MARCIA (MPH, RD, LDN, CDCES)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:MPH, RD, LDN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 45TH AVE
Mailing Address - Street 2:
Mailing Address - City:ST PETE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33706-2524
Mailing Address - Country:US
Mailing Address - Phone:813-460-8792
Mailing Address - Fax:
Practice Address - Street 1:229 45TH AVE
Practice Address - Street 2:
Practice Address - City:ST PETE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33706-2524
Practice Address - Country:US
Practice Address - Phone:813-460-8792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND8427133V00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered