Provider Demographics
NPI:1447047170
Name:OBANNON, JANINE (RD)
Entity type:Individual
Prefix:
First Name:JANINE
Middle Name:
Last Name:OBANNON
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:JANINE
Other - Middle Name:
Other - Last Name:SIGNORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:15121 RASMUSSEN RD
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33982-7719
Mailing Address - Country:US
Mailing Address - Phone:239-223-7535
Mailing Address - Fax:
Practice Address - Street 1:15121 RASMUSSEN RD
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33982-7719
Practice Address - Country:US
Practice Address - Phone:239-223-7535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND8007133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered