Provider Demographics
NPI:1861000226
Name:PINCOMBE, JESSICA (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PINCOMBE
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12231 JOSHUA TREE TRL
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-6535
Mailing Address - Country:US
Mailing Address - Phone:330-419-1017
Mailing Address - Fax:
Practice Address - Street 1:1928 PROCTOR AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-4200
Practice Address - Country:US
Practice Address - Phone:407-490-3279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND9559133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty