Provider Demographics
NPI:1447773932
Name:MEYER, JACQUELYN S (MPH, RDN, ATC, CEDRD)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:S
Last Name:MEYER
Suffix:
Gender:F
Credentials:MPH, RDN, ATC, CEDRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 5TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-6904
Mailing Address - Country:US
Mailing Address - Phone:727-490-8811
Mailing Address - Fax:727-502-2005
Practice Address - Street 1:33 6TH ST S STE 200
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4117
Practice Address - Country:US
Practice Address - Phone:727-490-8811
Practice Address - Fax:727-502-2005
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND7846133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered