Provider Demographics
NPI:1669039285
Name:MANN, JENNIFER (MS, RD, CSR)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MANN
Suffix:
Gender:F
Credentials:MS, RD, CSR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 W BROWARD BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-1315
Mailing Address - Country:US
Mailing Address - Phone:954-787-2554
Mailing Address - Fax:
Practice Address - Street 1:2630 W BROWARD BLVD STE 203
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-1315
Practice Address - Country:US
Practice Address - Phone:954-787-2554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-20
Last Update Date:2021-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133VN1005X
FLND8305133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal