Basic Information
| Provider Information | |||||||||
| NPI: | 1316921851 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOOKER | ||||||||
| FirstName: | ELLEN | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | RD CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 5TH AVE NORTH | ||||||||
| Address2: | STE 302 | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337051457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278212388 | ||||||||
| FaxNumber: | 7278216887 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 5TH AVE NORTH | ||||||||
| Address2: | STE 302 | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337051457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278212388 | ||||||||
| FaxNumber: | 7278216887 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2005 | ||||||||
| LastUpdateDate: | 11/05/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133N00000X | ND613 | FL | Y | Dietary & Nutritional Service Providers | Nutritionist |
ID Information
| ID | Type | State | Issuer | Description | N0187 | 01 | FL | BLUE SHIELD OF FLORIDA | OTHER | P00126506 | 01 | RAILROAD RETIREMENT MEDIC | OTHER |