Basic Information
| Provider Information | |||||||||
| NPI: | 1962878702 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOBLER | ||||||||
| FirstName: | INGRID | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | MS, RD, LDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 909 SW 255TH ST | ||||||||
| Address2: | |||||||||
| City: | NEWBERRY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326694943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2282343498 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1600 SW ARCHER RD | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326100325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522650111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2015 | ||||||||
| LastUpdateDate: | 08/17/2015 | ||||||||
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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 | 133V00000X | ND 7189 | FL | Y | Dietary & Nutritional Service Providers | Dietitian, Registered | 133V00000X | LDN0000002669 | TN | N | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.