Provider Demographics
NPI:1881658755
Name:RHOULHAC, JEANNA L (RD LDN CDE)
Entity Type:Individual
Prefix:
First Name:JEANNA
Middle Name:L
Last Name:RHOULHAC
Suffix:
Gender:F
Credentials:RD LDN CDE
Other - Prefix:
Other - First Name:JEANNA
Other - Middle Name:L
Other - Last Name:EASLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD LDN CDE
Mailing Address - Street 1:1700 NW 49TH ST STE 125
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3750
Mailing Address - Country:US
Mailing Address - Phone:954-463-7313
Mailing Address - Fax:954-527-6082
Practice Address - Street 1:1111 W BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-1638
Practice Address - Country:US
Practice Address - Phone:954-463-7313
Practice Address - Fax:954-527-6082
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND1730133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE7522ZMedicare ID - Type Unspecified