Provider Demographics
NPI:1205599719
Name:KLECKNER, VICTORIA REGINA (RDN)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:REGINA
Last Name:KLECKNER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 SW 1ST AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-6515
Mailing Address - Country:US
Mailing Address - Phone:352-368-1661
Mailing Address - Fax:
Practice Address - Street 1:1627 SW 1ST AVE STE 100
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6515
Practice Address - Country:US
Practice Address - Phone:352-368-1661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND10631136A00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered