Provider Demographics
NPI:1629343322
Name:BARBER, GINNIFER LEE (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:GINNIFER
Middle Name:LEE
Last Name:BARBER
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:MISS
Other - First Name:GINNIFER
Other - Middle Name:LEE
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:1609 PHYSICIANS DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4620
Mailing Address - Country:US
Mailing Address - Phone:850-878-1171
Mailing Address - Fax:850-942-1291
Practice Address - Street 1:1609 PHYSICIANS DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4620
Practice Address - Country:US
Practice Address - Phone:850-878-1171
Practice Address - Fax:850-942-1291
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL898664133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered