Basic Information
| Provider Information | |||||||||
| NPI: | 1750324984 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JORGENSEN | ||||||||
| FirstName: | KRISTIN | ||||||||
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| Credential: | RD, LD/N | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5337 N HIGHLAND PARK DR | ||||||||
| Address2: | |||||||||
| City: | HERNANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344422633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3524450282 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14540 CORTEZ BLVD | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | BROOKSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525978287 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 01/16/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | ND2935 | FL | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.