Provider Demographics
NPI:1598096570
Name:CARSON, ELLAREETHA TRUEBLOOD (RD,LD)
Entity Type:Individual
Prefix:MRS
First Name:ELLAREETHA
Middle Name:TRUEBLOOD
Last Name:CARSON
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:MRS
Other - First Name:ELLAREETHA
Other - Middle Name:TRUEBLOOD
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:4057 E MARYLAND PL
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-5262
Mailing Address - Country:US
Mailing Address - Phone:407-696-4096
Mailing Address - Fax:407-696-4096
Practice Address - Street 1:2009 W CENTRAL BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-2124
Practice Address - Country:US
Practice Address - Phone:407-872-1333
Practice Address - Fax:407-872-7135
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND2349133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist