Provider Demographics
NPI:1972969475
Name:ROVANSEK, NELLIE (RD, LD)
Entity type:Individual
Prefix:
First Name:NELLIE
Middle Name:
Last Name:ROVANSEK
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 NATIONAL HEALTH CARE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-1495
Mailing Address - Country:US
Mailing Address - Phone:407-664-0444
Mailing Address - Fax:
Practice Address - Street 1:2219 DARTMOUTH RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-3429
Practice Address - Country:US
Practice Address - Phone:706-414-4104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-13
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003932133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered