Provider Demographics
NPI:1497415996
Name:WHITE, JILL HIER (EDD, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:HIER
Last Name:WHITE
Suffix:
Gender:F
Credentials:EDD, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16540 SPRING PARK DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-7920
Mailing Address - Country:US
Mailing Address - Phone:630-742-0444
Mailing Address - Fax:
Practice Address - Street 1:16540 SPRING PARK DR
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-7920
Practice Address - Country:US
Practice Address - Phone:630-742-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8886133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered