Provider Demographics
NPI:1831749001
Name:JOLLIFFE, TANYA L (RDN, LD)
Entity type:Individual
Prefix:MS
First Name:TANYA
Middle Name:L
Last Name:JOLLIFFE
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7917 W GATE PARK
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-7812
Mailing Address - Country:US
Mailing Address - Phone:513-659-3017
Mailing Address - Fax:
Practice Address - Street 1:7917 W GATE PARK
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-7812
Practice Address - Country:US
Practice Address - Phone:513-659-3017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD2858133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered