Provider Demographics
NPI:1699043828
Name:DORAN, DEANNA (RD)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:DORAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4704B W MONTGOMERY AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33616-1042
Mailing Address - Country:US
Mailing Address - Phone:813-559-4159
Mailing Address - Fax:
Practice Address - Street 1:4704B W MONTGOMERY AVE STE 1
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33616-1042
Practice Address - Country:US
Practice Address - Phone:813-559-4159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered