Provider Demographics
NPI:1780813733
Name:TALLEDA, JENNA ROSE (RD, LD/N, CIEC)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:ROSE
Last Name:TALLEDA
Suffix:
Gender:F
Credentials:RD, LD/N, CIEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1448 CHURCHILL CIR # S204
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34116-3613
Mailing Address - Country:US
Mailing Address - Phone:239-338-7420
Mailing Address - Fax:239-433-6703
Practice Address - Street 1:1448 CHURCHILL CIR # S204
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116-3613
Practice Address - Country:US
Practice Address - Phone:239-338-7420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5196133V00000X, 133N00000X, 133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered