Provider Demographics
NPI:1598206567
Name:KREMNITZER, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:KREMNITZER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2385 NW EXECUTIVE CENTER DR
Mailing Address - Street 2:STE 100
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-8579
Mailing Address - Country:US
Mailing Address - Phone:561-962-2719
Mailing Address - Fax:
Practice Address - Street 1:2385 NW EXECUTIVE CENTER DR
Practice Address - Street 2:STE 100
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-8579
Practice Address - Country:US
Practice Address - Phone:561-962-2719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7335133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered