Provider Demographics
NPI:1245396050
Name:FORESTIERI, THOMAS V (RD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:V
Last Name:FORESTIERI
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 NW 33RD PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-2001
Mailing Address - Country:US
Mailing Address - Phone:928-304-2394
Mailing Address - Fax:
Practice Address - Street 1:3520 NW 33RD PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-2001
Practice Address - Country:US
Practice Address - Phone:928-304-2394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3577363AM0700X
FLND1277133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical