Provider Demographics
NPI:1760708788
Name:EBERSOLE, CATHERINE A (ND)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:EBERSOLE
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:A
Other - Last Name:SERRAO-EBERSOLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ND
Mailing Address - Street 1:700 8TH AVE W
Mailing Address - Street 2:STE 101
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-4737
Mailing Address - Country:US
Mailing Address - Phone:941-776-4008
Mailing Address - Fax:941-845-4963
Practice Address - Street 1:5325 26TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-3012
Practice Address - Country:US
Practice Address - Phone:941-752-7173
Practice Address - Fax:941-567-6277
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND1134133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered