Provider Demographics
NPI:1134971278
Name:POWELL, JULYNNET (RDN, LDN)
Entity type:Individual
Prefix:
First Name:JULYNNET
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6135 SE STETSON RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-8434
Mailing Address - Country:US
Mailing Address - Phone:863-712-9187
Mailing Address - Fax:
Practice Address - Street 1:6135 SE STETSON RD
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-8434
Practice Address - Country:US
Practice Address - Phone:863-712-9187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND11225133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered