Provider Demographics
NPI:1184945974
Name:MARN, JOAN A (MS, RD, LD/N)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:A
Last Name:MARN
Suffix:
Gender:F
Credentials:MS, RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10280 SW 124TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-4845
Mailing Address - Country:US
Mailing Address - Phone:305-256-4242
Mailing Address - Fax:305-256-4476
Practice Address - Street 1:10280 SW 124TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-4845
Practice Address - Country:US
Practice Address - Phone:305-256-4242
Practice Address - Fax:305-256-4476
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0000230133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered