Provider Demographics
NPI:1558148700
Name:QUIGLEY, JANTELLE EILEEN (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:JANTELLE
Middle Name:EILEEN
Last Name:QUIGLEY
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3672 TORRE GRANDE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-6941
Mailing Address - Country:US
Mailing Address - Phone:228-223-7247
Mailing Address - Fax:
Practice Address - Street 1:3672 TORRE GRANDE AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-6941
Practice Address - Country:US
Practice Address - Phone:228-223-7247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10932133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty