Provider Demographics
NPI:1811177876
Name:HEALY MARQUES, ELIZABETH (MS RD LD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:HEALY MARQUES
Suffix:
Gender:F
Credentials:MS RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 E 138TH AVE
Mailing Address - Street 2:SUITE 12
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3904
Mailing Address - Country:US
Mailing Address - Phone:813-975-2800
Mailing Address - Fax:
Practice Address - Street 1:3010 E 138TH AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3904
Practice Address - Country:US
Practice Address - Phone:813-975-2800
Practice Address - Fax:813-977-7631
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2012-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 3809133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
A1759ZMedicare PIN