Provider Demographics
NPI:1417120007
Name:LANTZ, TAMMY (RD, LD)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:LANTZ
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 BAYSHORE DR
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-3401
Mailing Address - Country:US
Mailing Address - Phone:850-659-3557
Mailing Address - Fax:
Practice Address - Street 1:1435 BAYSHORE DR
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-3401
Practice Address - Country:US
Practice Address - Phone:850-659-3557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-04
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO921681133V00000X, 133VN1004X
FLND7399133V00000X
CO11190656174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No174N00000XOther Service ProvidersLactation Consultant, Non-RN