Provider Demographics
NPI:1982036695
Name:WILDER, DARBIE LEIGH (RD)
Entity Type:Individual
Prefix:MRS
First Name:DARBIE
Middle Name:LEIGH
Last Name:WILDER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 VALENCIA CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1298
Mailing Address - Country:US
Mailing Address - Phone:813-748-9303
Mailing Address - Fax:
Practice Address - Street 1:184 VALENCIA CIR
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-1298
Practice Address - Country:US
Practice Address - Phone:813-748-9303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5225133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered