Healthcare Provider Details

I. General information

NPI: 1508526237
Provider Name (Legal Business Name): JENNA YELENOSKY RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2021
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 MAIN ST
ATLANTIC BEACH FL
32233-2546
US

IV. Provider business mailing address

719 MAIN ST
ATLANTIC BEACH FL
32233-2546
US

V. Phone/Fax

Practice location:
  • Phone: 407-267-0450
  • Fax:
Mailing address:
  • Phone: 407-267-0450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberND10555
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86108966
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: