Healthcare Provider Details

I. General information

NPI: 1316851843
Provider Name (Legal Business Name): ABBY RICICA NDTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14611 SOUTHERN BLVD UNIT 1098
LOXAHATCHEE FL
33470-6848
US

IV. Provider business mailing address

14611 SOUTHERN BLVD UNIT 1098
LOXAHATCHEE FL
33470-6848
US

V. Phone/Fax

Practice location:
  • Phone: 614-985-6567
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code136A00000X
TaxonomyRegistered Dietetic Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: