Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CH 11029 | FL |
NPI | 1467880559 |
---|---|
Provider Name | Kristin Hartjes |
First Address | Longwood, FL 32750-4151 |
Second Address | Longwood, FL 32750-4151 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2013 |
Last Update Date | 29/10/2013 |