Provider Demographics
NPI:1417586330
Name:ALLEN, SARAH NICOLE (MS, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:NICOLE
Last Name:ALLEN
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 1:10000 GATE PKWY N APT 816
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-8210
Mailing Address - Country:US
Mailing Address - Phone:229-834-0934
Mailing Address - Fax:
Practice Address - Street 1:10000 GATE PKWY N APT 816
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-8210
Practice Address - Country:US
Practice Address - Phone:229-834-0934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-02
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9715133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered