Provider Demographics
NPI:1407611924
Name:KRUSEN, MERRILL BRADY (RDN)
Entity Type:Individual
Prefix:MRS
First Name:MERRILL
Middle Name:BRADY
Last Name:KRUSEN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 W SWANN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2590
Mailing Address - Country:US
Mailing Address - Phone:215-805-8230
Mailing Address - Fax:
Practice Address - Street 1:1414 W SWANN AVE STE 100
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2590
Practice Address - Country:US
Practice Address - Phone:215-805-8230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND9986133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered