Provider Demographics
NPI:1932503489
Name:JENNINGS, STEPHANIE (MS,RD, LDN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:MS,RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 ATWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-7502
Mailing Address - Country:US
Mailing Address - Phone:850-512-7037
Mailing Address - Fax:850-476-4307
Practice Address - Street 1:1505 ATWOOD DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-7502
Practice Address - Country:US
Practice Address - Phone:850-512-7037
Practice Address - Fax:850-476-4307
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND2246133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered