Provider Demographics
NPI:1508917998
Name:JANTAC, CAROLINA LIMA (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:LIMA
Last Name:JANTAC
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 BRIDLE PATH WAY
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34688-7209
Mailing Address - Country:US
Mailing Address - Phone:727-459-9020
Mailing Address - Fax:
Practice Address - Street 1:404 BRIDLE PATH WAY
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34688-7209
Practice Address - Country:US
Practice Address - Phone:727-459-9020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered