Provider Demographics
NPI:1386509172
Name:TIPTON, MARY (MS, RDN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:TIPTON
Suffix:
Gender:X
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9868 SHERBROOK LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-1264
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9868 SHERBROOK LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-1264
Practice Address - Country:US
Practice Address - Phone:912-504-1659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-23
Last Update Date:2025-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered