Provider Demographics
NPI:1659466548
Name:TRCALEK, CATHERINE LEBLANC (RD, LD/N, CDE)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:LEBLANC
Last Name:TRCALEK
Suffix:
Gender:F
Credentials:RD, LD/N, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 UNIVERSITY BLVD S
Mailing Address - Street 2:STE. 220
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-2758
Mailing Address - Country:US
Mailing Address - Phone:904-724-2043
Mailing Address - Fax:904-724-2013
Practice Address - Street 1:3100 UNIVERSITY BLVD S
Practice Address - Street 2:STE. 220
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-2758
Practice Address - Country:US
Practice Address - Phone:904-724-2043
Practice Address - Fax:904-724-2013
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND2774133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE7132ZMedicare ID - Type UnspecifiedMEDICARE