Provider Demographics
NPI:1952908204
Name:MEZZETTI, KIMBERLY (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MEZZETTI
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1439 S LADERA TER
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-3631
Mailing Address - Country:US
Mailing Address - Phone:561-654-6534
Mailing Address - Fax:
Practice Address - Street 1:4826 SW 49TH RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-6299
Practice Address - Country:US
Practice Address - Phone:561-654-6534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10037133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education