Provider Demographics
NPI:1720552243
Name:FARNSWORTH, LAURA C (MS, CNS)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:C
Last Name:FARNSWORTH
Suffix:
Gender:F
Credentials:MS, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4522 W VILLAGE DR UNIT 1081
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-3429
Mailing Address - Country:US
Mailing Address - Phone:442-444-0018
Mailing Address - Fax:
Practice Address - Street 1:4522 W VILLAGE DR UNIT 1081
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-3429
Practice Address - Country:US
Practice Address - Phone:442-444-0018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-17
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty