Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CH13334 | FL |
NPI | 1154878841 |
---|---|
Provider Name | Robyn Klepko |
First Address | Clearwater, FL 33755-2150 |
Second Address | Clearwater, FL 33755-2150 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2016 |
Last Update Date | 15/11/2021 |