Provider Demographics
NPI:1457914434
Name:STEWART, TEMPLE GENE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:TEMPLE
Middle Name:GENE
Last Name:STEWART
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 48TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-3636
Mailing Address - Country:US
Mailing Address - Phone:601-447-1262
Mailing Address - Fax:
Practice Address - Street 1:1100 48TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-3636
Practice Address - Country:US
Practice Address - Phone:601-447-1262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND8833133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLND8833OtherFLORIDA LICENSURE FOR DIETITIANS