Provider Demographics
NPI:1477811172
Name:SPICOCCHI, ANN MARIE (RD,CSO,LD/N)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:SPICOCCHI
Suffix:
Gender:F
Credentials:RD,CSO,LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 S HOWARD AVE APT B8
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3143
Mailing Address - Country:US
Mailing Address - Phone:813-277-8112
Mailing Address - Fax:
Practice Address - Street 1:12902 USF MAGNOLIA DR
Practice Address - Street 2:MOD-C NUTHER
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-9416
Practice Address - Country:US
Practice Address - Phone:813-745-1141
Practice Address - Fax:813-449-8484
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 5248133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered