1295161040 NPI number — THE DIETITIANS GROUP OF WEST FLORIDA, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295161040 NPI number — THE DIETITIANS GROUP OF WEST FLORIDA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE DIETITIANS GROUP OF WEST FLORIDA, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295161040
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7143 STATE ROAD 54 UNIT 121
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW PORT RICHEY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34653-6104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-376-9757
Provider Business Mailing Address Fax Number:
727-245-8670

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34921 US HIGHWAY 19 N STE 340
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALM HARBOR
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34684-1969
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-376-9757
Provider Business Practice Location Address Fax Number:
727-245-8670
Provider Enumeration Date:
09/24/2013

Additional Information

Authorized Official

Authorized Official Last Name:
WITKOWSKI
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER/CEO
Authorized Official Telephone Number:
727-376-9757

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  ND5272 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com