Provider Demographics
NPI:1750324984
Name:JORGENSEN, KRISTIN (RD, LD/N)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5337 N HIGHLAND PARK DR
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:FL
Mailing Address - Zip Code:34442-2633
Mailing Address - Country:US
Mailing Address - Phone:352-445-0282
Mailing Address - Fax:
Practice Address - Street 1:14540 CORTEZ BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613
Practice Address - Country:US
Practice Address - Phone:352-597-8287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND2935133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered