Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN1001X | Nutrition | CH5136 | FL |
N | 111NN1001X | Nutrition | X006809-1 | NY |
NPI | 1144380023 |
---|---|
Provider Name | Dr. Geraldine Marie Krista |
First Address | Orange City, FL 32774-1501 |
Second Address | Orange City, FL 32763-7727 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 08/07/2007 |