Provider Demographics
NPI:1437592441
Name:TELLER, JOANN CORINNE (RD)
Entity Type:Individual
Prefix:MS
First Name:JOANN
Middle Name:CORINNE
Last Name:TELLER
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 1:7099 BRACKEN LN
Mailing Address - Street 2:
Mailing Address - City:VIERA
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7986
Mailing Address - Country:US
Mailing Address - Phone:321-537-3275
Mailing Address - Fax:
Practice Address - Street 1:7099 BRACKEN LN
Practice Address - Street 2:
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940-7986
Practice Address - Country:US
Practice Address - Phone:321-537-3275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 5532133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered