Provider Demographics
NPI:1245678580
Name:RANKINS, JENICE (EDD, RD, LD/N)
Entity type:Individual
Prefix:DR
First Name:JENICE
Middle Name:
Last Name:RANKINS
Suffix:
Gender:F
Credentials:EDD, 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 1:1330 BLOCKFORD CT W
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-8462
Mailing Address - Country:US
Mailing Address - Phone:850-408-0507
Mailing Address - Fax:
Practice Address - Street 1:1330 BLOCKFORD CT W
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32317-8462
Practice Address - Country:US
Practice Address - Phone:850-408-0507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-09
Last Update Date:2013-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1024050133V00000X
FLND5667133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered