Provider Demographics
NPI:1730075375
Name:JOHN-GOODRICH, DANA LYN (MPH, RD)
Entity type:Individual
Prefix:MS
First Name:DANA
Middle Name:LYN
Last Name:JOHN-GOODRICH
Suffix:
Gender:F
Credentials:MPH, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96149 HANGING MOSS DR
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-5874
Mailing Address - Country:US
Mailing Address - Phone:516-236-9252
Mailing Address - Fax:
Practice Address - Street 1:96149 HANGING MOSS DR
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-5874
Practice Address - Country:US
Practice Address - Phone:516-236-9252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND14376133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered