Provider Demographics
NPI:1407494875
Name:WORTHINGTON, KRISTINA (MSH, RD, CSSD, LD/N)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:WORTHINGTON
Suffix:
Gender:F
Credentials:MSH, RD, CSSD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8291 BARRACUDA RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-1203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4555 EMERSON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-4966
Practice Address - Country:US
Practice Address - Phone:904-294-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4383133NN1002X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered