Provider Demographics
NPI:1669831285
Name:BLEIWEIS, JENNIFER MORRIS (RD)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MORRIS
Last Name:BLEIWEIS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3517 SW 92ND ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-8673
Mailing Address - Country:US
Mailing Address - Phone:352-275-7852
Mailing Address - Fax:
Practice Address - Street 1:5341 SW 91ST TER
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-8108
Practice Address - Country:US
Practice Address - Phone:352-275-7852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-11
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5255133V00000X
171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No171400000XOther Service ProvidersHealth & Wellness Coach