Healthcare Provider Details

I. General information

NPI: 1780813733
Provider Name (Legal Business Name): JENNA ROSE TALLEDA R.D., L.D./N, CIEC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1448 CHURCHILL CIR # S204
NAPLES FL
34116-3613
US

IV. Provider business mailing address

1448 CHURCHILL CIR # S204
NAPLES FL
34116-3613
US

V. Phone/Fax

Practice location:
  • Phone: 239-338-7420
  • Fax:
Mailing address:
  • Phone: 239-338-7420
  • Fax: 239-433-6703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberND5196
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND5196
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: