Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CH7379 | FL |
NPI | 1164627634 |
---|---|
Provider Name | Carolyn Alice Cleland-Reid |
First Address | Jacksonville, FL 32225-7332 |
Second Address | Jacksonville, FL 32225-7332 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2007 |
Last Update Date | 04/01/2011 |