Provider Demographics
NPI:1982858098
Name:FORSS, LONNA (RD)
Entity Type:Individual
Prefix:
First Name:LONNA
Middle Name:
Last Name:FORSS
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 1:822 BEVERLY AVE
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-1017
Mailing Address - Country:US
Mailing Address - Phone:727-742-6562
Mailing Address - Fax:
Practice Address - Street 1:822 BEVERLY AVE
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-1017
Practice Address - Country:US
Practice Address - Phone:727-742-6562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 3714133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered