Healthcare Provider Details

I. General information

NPI: 1376946632
Provider Name (Legal Business Name): ANDREA SOLLENBERGER RD, RDN, LD/N
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4423 NW 6TH PL STE A
GAINESVILLE FL
32607-6116
US

IV. Provider business mailing address

4423 NW 6TH PL STE A
GAINESVILLE FL
32607-6116
US

V. Phone/Fax

Practice location:
  • Phone: 352-213-1250
  • Fax:
Mailing address:
  • Phone: 352-213-1250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number639704
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number639704
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number639704
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number639704
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number639704
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number639704
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: