Provider Demographics
NPI:1417702754
Name:NEWMAN, JODI B (RD)
Entity Type:Individual
Prefix:MS
First Name:JODI
Middle Name:B
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2246 SW CROCUS LN
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-5710
Mailing Address - Country:US
Mailing Address - Phone:772-370-1522
Mailing Address - Fax:
Practice Address - Street 1:2246 SW CROCUS LN
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-5710
Practice Address - Country:US
Practice Address - Phone:772-370-1522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND7403133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered