Provider Demographics
NPI:1629527270
Name:CARDIN, JESSICA L (MS RD CSSD LD/N)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:CARDIN
Suffix:
Gender:F
Credentials:MS RD CSSD LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 VICTOR WHARF ACCESS RD
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-3400
Mailing Address - Country:US
Mailing Address - Phone:808-474-2698
Mailing Address - Fax:
Practice Address - Street 1:1 HUME DRIVE
Practice Address - Street 2:
Practice Address - City:HURLBURT FIELD
Practice Address - State:FL
Practice Address - Zip Code:32544
Practice Address - Country:US
Practice Address - Phone:808-474-2698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN86012244133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered