Provider Demographics
NPI:1417527359
Name:STARGEL, CLANCY BRYANT (RD)
Entity Type:Individual
Prefix:
First Name:CLANCY
Middle Name:BRYANT
Last Name:STARGEL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:CLANCY
Other - Middle Name:
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:525 SW 41ST ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2763
Mailing Address - Country:US
Mailing Address - Phone:843-737-2663
Mailing Address - Fax:
Practice Address - Street 1:525 SW 41ST ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2763
Practice Address - Country:US
Practice Address - Phone:843-737-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD005205133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered