Healthcare Provider Details

I. General information

NPI: 1861222523
Provider Name (Legal Business Name): AMANDA M TOIVOLA MS, RD, LD/N, CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

12311 KENSINGTON LAKES DR UNIT 1404
JACKSONVILLE FL
32246-1366
US

IV. Provider business mailing address

12311 KENSINGTON LAKES DR UNIT 1404
JACKSONVILLE FL
32246-1366
US

V. Phone/Fax

Practice location:
  • Phone: 770-708-2962
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND10567
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: