Provider Demographics
NPI:1245251784
Name:LAYTON, TINA CAROLYN (RD)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:CAROLYN
Last Name:LAYTON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 FOUNDRY ST
Mailing Address - Street 2:STE 101
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-5421
Mailing Address - Country:US
Mailing Address - Phone:888-320-1776
Mailing Address - Fax:
Practice Address - Street 1:15 RYE ST 225
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-6830
Practice Address - Country:US
Practice Address - Phone:888-320-1776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH390133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHMT0663Medicare ID - Type Unspecified