Provider Demographics
NPI:1003618695
Name:GOSSETT, MARIEL SARAH (MS, RDN, LD/N)
Entity type:Individual
Prefix:
First Name:MARIEL
Middle Name:SARAH
Last Name:GOSSETT
Suffix:
Gender:
Credentials:MS, RDN, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15701 COUNTRY LAKE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1514
Mailing Address - Country:US
Mailing Address - Phone:334-758-8610
Mailing Address - Fax:
Practice Address - Street 1:15701 COUNTRY LAKE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-1514
Practice Address - Country:US
Practice Address - Phone:334-758-8610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND12337133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered