Healthcare Provider Details

I. General information

NPI: 1477858603
Provider Name (Legal Business Name): JENNIFER ANNE DUERR RD, LD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2011
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5051 CARPENTER CREEK DR
PENSACOLA FL
32503-2521
US

IV. Provider business mailing address

5051 CARPENTER CREEK DR
PENSACOLA FL
32503-2521
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-6408
  • Fax: 850-416-7246
Mailing address:
  • Phone: 850-416-6408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND2142
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: