Provider Demographics
NPI:1942502257
Name:BROWN- LEWIS, JENNIFER N (RD, LD/N)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:N
Last Name:BROWN- LEWIS
Suffix:
Gender:F
Credentials:RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4259 TANGLEWILDE DR S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-6438
Mailing Address - Country:US
Mailing Address - Phone:904-571-2851
Mailing Address - Fax:904-359-3816
Practice Address - Street 1:5322 N PEARL ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-5119
Practice Address - Country:US
Practice Address - Phone:904-571-2851
Practice Address - Fax:904-359-3816
Is Sole Proprietor?:No
Enumeration Date:2010-11-19
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5843133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered