Provider Demographics
NPI:1508526237
Name:YELENOSKY, JENNA (RDN, LD/N)
Entity Type:Individual
Prefix:MS
First Name:JENNA
Middle Name:
Last Name:YELENOSKY
Suffix:
Gender:F
Credentials:RDN, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 2ND AVE N UNIT B
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-4412
Mailing Address - Country:US
Mailing Address - Phone:407-267-0450
Mailing Address - Fax:
Practice Address - Street 1:708 2ND AVE N UNIT B
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-4412
Practice Address - Country:US
Practice Address - Phone:407-267-0450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND10555133NN1002X
FL86108966133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education