Provider Demographics
NPI:1417122839
Name:HEARN, DIONNA JOY
Entity Type:Individual
Prefix:MISS
First Name:DIONNA
Middle Name:JOY
Last Name:HEARN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIONNA
Other - Middle Name:JOY
Other - Last Name:HEARN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD, LD/N
Mailing Address - Street 1:PO BOX 5991
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33310-5991
Mailing Address - Country:US
Mailing Address - Phone:954-288-9476
Mailing Address - Fax:
Practice Address - Street 1:1301 S ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1823
Practice Address - Country:US
Practice Address - Phone:954-288-9476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-26
Last Update Date:2008-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4636133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered