Provider Demographics
NPI:1457124372
Name:WIDEN, ALANA (RD, LDN, ISAK-1)
Entity type:Individual
Prefix:
First Name:ALANA
Middle Name:
Last Name:WIDEN
Suffix:
Gender:F
Credentials:RD, LDN, ISAK-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4571 LEEWARD RIDGE DR APT 201
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-6853
Mailing Address - Country:US
Mailing Address - Phone:708-476-8048
Mailing Address - Fax:
Practice Address - Street 1:4571 LEEWARD RIDGE DR APT 201
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-6853
Practice Address - Country:US
Practice Address - Phone:708-476-8048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND11253133VN1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics