Provider Demographics
NPI:1407636087
Name:BOSWELL, VERONICA BROGAN (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:BROGAN
Last Name:BOSWELL
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 S WHETHERBINE WAY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-8567
Mailing Address - Country:US
Mailing Address - Phone:315-200-9781
Mailing Address - Fax:
Practice Address - Street 1:123 S WHETHERBINE WAY
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-8567
Practice Address - Country:US
Practice Address - Phone:315-200-9781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL86148064133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered