Healthcare Provider Details

I. General information

NPI: 1417120007
Provider Name (Legal Business Name): TAMMY LANTZ RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2008
Last Update Date: 07/05/2021
Certification Date: 07/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 BAYSHORE DR
NICEVILLE FL
32578-3401
US

IV. Provider business mailing address

1435 BAYSHORE DR
NICEVILLE FL
32578-3401
US

V. Phone/Fax

Practice location:
  • Phone: 850-659-3557
  • Fax:
Mailing address:
  • Phone: 850-659-3557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number921681
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND7399
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number921681
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number11190656
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: