Provider Demographics
NPI:1942562236
Name:WORTHEN, NAJWA NA-IMAH (DC, MPH, RD)
Entity Type:Individual
Prefix:DR
First Name:NAJWA
Middle Name:NA-IMAH
Last Name:WORTHEN
Suffix:
Gender:F
Credentials:DC, MPH, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 7TH ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-3620
Mailing Address - Country:US
Mailing Address - Phone:386-956-5945
Mailing Address - Fax:
Practice Address - Street 1:1340 7TH ST
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-3620
Practice Address - Country:US
Practice Address - Phone:386-956-5945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10557111N00000X
FLND 4355133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No111N00000XChiropractic ProvidersChiropractor