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NPI Code Detail

MEDICARE: GRACE ALLEN RDN

MEDICARE:   GRACE  ALLEN  RDN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian12744FL

General Provider Information

NPI Number : 1013748607
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE ALLEN RDN
Provider Business Mailing Address
First Line : 2695 POST ST
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32204-4230
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2695 POST ST
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32204-4230
Country : US
Telephone Number : 904-515-8920
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2024
Last Update Date : 01/17/2026

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Directions to “ GRACE ALLEN RDN” Practice Location

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