Provider Demographics
NPI:1942727078
Name:BARRELL, JENNIFER (LDN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BARRELL
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15341 CORTONA WAY
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34120-0675
Mailing Address - Country:US
Mailing Address - Phone:954-661-0435
Mailing Address - Fax:
Practice Address - Street 1:3531 BONITA BAY BLVD STE 300
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-1704
Practice Address - Country:US
Practice Address - Phone:239-676-5249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND8375133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist