Provider Demographics
NPI:1457342115
Name:JENNINGS, CAROL H (MPH RD LD)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:H
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:MPH RD LD
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:HIPPARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD LD
Mailing Address - Street 1:PO BOX 612
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:FL
Mailing Address - Zip Code:33576-0612
Mailing Address - Country:US
Mailing Address - Phone:352-588-0963
Mailing Address - Fax:
Practice Address - Street 1:7050 GALL BLVD
Practice Address - Street 2:EAST PASCO MEDICAL CENTER
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541-1347
Practice Address - Country:US
Practice Address - Phone:813-744-0411
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND00002001133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered