Healthcare Provider Details

I. General information

NPI: 1164374500
Provider Name (Legal Business Name): CAROLINA RANCIER BARINAS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 N MAGNOLIA AVE STE 202
ORLANDO FL
32803-3220
US

IV. Provider business mailing address

924 N MAGNOLIA AVE STE 202
ORLANDO FL
32803-3220
US

V. Phone/Fax

Practice location:
  • Phone: 407-286-4366
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND14877
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: