Provider Demographics
NPI:1881823060
Name:HOWARD-GONZALEZ, DEANNA M (RD, LD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:M
Last Name:HOWARD-GONZALEZ
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:MRS
Other - First Name:DEANNA
Other - Middle Name:M
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD, CDE
Mailing Address - Street 1:115 MIRACLE STRIP PKWY SE UNIT 101
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-5976
Mailing Address - Country:US
Mailing Address - Phone:850-374-7604
Mailing Address - Fax:850-792-2545
Practice Address - Street 1:115 MIRACLE STRIP PKWY SE UNIT 101
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5976
Practice Address - Country:US
Practice Address - Phone:850-374-7604
Practice Address - Fax:850-792-2545
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND3885133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLND3885OtherFLORIDA