Provider Demographics
NPI:1851684146
Name:NOVAK, GUDRUN LOMHOLT (RD, LDN, DCES)
Entity Type:Individual
Prefix:MRS
First Name:GUDRUN
Middle Name:LOMHOLT
Last Name:NOVAK
Suffix:
Gender:F
Credentials:RD, LDN, DCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3555
Mailing Address - Country:US
Mailing Address - Phone:941-917-2090
Mailing Address - Fax:941-917-7590
Practice Address - Street 1:1700 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3555
Practice Address - Country:US
Practice Address - Phone:941-917-2090
Practice Address - Fax:941-917-7590
Is Sole Proprietor?:No
Enumeration Date:2011-05-19
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND7051133V00000X
NCL002365133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric