Provider Demographics
NPI:1629855333
Name:SIMPSON, ISABELLA (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:ISABELLA
Middle Name:
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11262 SW VILLAGE CT APT 203
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-4410
Mailing Address - Country:US
Mailing Address - Phone:336-471-6772
Mailing Address - Fax:
Practice Address - Street 1:11262 SW VILLAGE CT APT 203
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-4410
Practice Address - Country:US
Practice Address - Phone:336-471-6772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND12413133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered