Provider Demographics
NPI:1962854281
Name:ROBINSON, JENNIFER (RD LD/N)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ROBINSON
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 1:224 MEMORIAL MEDICAL PKWY
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5111
Mailing Address - Country:US
Mailing Address - Phone:386-231-4037
Mailing Address - Fax:386-615-9577
Practice Address - Street 1:224 MEMORIAL MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5111
Practice Address - Country:US
Practice Address - Phone:386-231-4037
Practice Address - Fax:386-615-9577
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 6305133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLND 6305OtherFLORIDA STATE LICENSE
852116OtherCOMMISSION ON DIETETIC REGISTRATION