Provider Demographics
NPI:1134353006
Name:DEAN, PATTI MARTIN (RD, LD, MBA)
Entity type:Individual
Prefix:
First Name:PATTI
Middle Name:MARTIN
Last Name:DEAN
Suffix:
Gender:F
Credentials:RD, LD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7458 FLEMING ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-9338
Mailing Address - Country:US
Mailing Address - Phone:904-284-3766
Mailing Address - Fax:
Practice Address - Street 1:7458 FLEMING ISLAND DR
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-9338
Practice Address - Country:US
Practice Address - Phone:904-284-3766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND550133V00000X, 133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal