Healthcare Provider Details

I. General information

NPI: 1518107176
Provider Name (Legal Business Name): ASHLEY NICOLE MORENO RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY NICOLE CHAPMAN RD

II. Dates (important events)

Enumeration Date: 02/23/2009
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15150 HARRINGTON COVE DR
ORLANDO FL
32824-4457
US

IV. Provider business mailing address

2929 CARLISLE ST SUITE 200
DALLAS TX
75204-1084
US

V. Phone/Fax

Practice location:
  • Phone: 817-905-0756
  • Fax:
Mailing address:
  • Phone: 214-348-5557
  • Fax: 214-348-5898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT81087
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND6174
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: