Healthcare Provider Details

I. General information

NPI: 1205235850
Provider Name (Legal Business Name): JACLYN RUTH ELKINS MS, RD, LDN, CNSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACLYN RUTH LAPS MS, RD, LDN, CNSC

II. Dates (important events)

Enumeration Date: 08/20/2014
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 SAN PABLO RD S
JACKSONVILLE FL
32224
US

IV. Provider business mailing address

4500 SAN PABLO RD S
JACKSONVILLE FL
32224-1865
US

V. Phone/Fax

Practice location:
  • Phone: 904-953-2000
  • Fax:
Mailing address:
  • Phone: 904-953-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND7769
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberND7769
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL004437
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberND7769
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberND7769
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: