Provider Demographics
NPI:1538647961
Name:VOGT, JOHANNA COUTINHO (MS, RDN, LD)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:COUTINHO
Last Name:VOGT
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:JOHANNA
Other - Middle Name:
Other - Last Name:COUTINHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2380 3RD ST S STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-8039
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2380 3RD ST S STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-8039
Practice Address - Country:US
Practice Address - Phone:904-270-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-28
Last Update Date:2018-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8811133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered