MEDICARE: MRS. CATHERINE LEBLANC TRCALEK RD, LD/N, CDE

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
1	133V00000X	Registered Dietitian	ND2774	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659466548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CATHERINE LEBLANC TRCALEK RD, LD/N, CDE

Provider Business Mailing Address
First Line	:	3100 UNIVERSITY BLVD S
Second Line	:	STE. 220
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-2758
Country	:	US
Telephone Number	:	904-724-2043
Fax Number	:	904-724-2013

Provider Business Practice Location Address
First Line	:	3100 UNIVERSITY BLVD S
Second Line	:	STE. 220
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-2758
Country	:	US
Telephone Number	:	904-724-2043
Fax Number	:	904-724-2013

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/08/2007

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Directions to “ MRS. CATHERINE LEBLANC TRCALEK RD, LD/N, CDE” Practice Location

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