Healthcare Provider Details

I. General information

NPI: 1902410939
Provider Name (Legal Business Name): JENA CARTAGINESE MS, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5153 N 9TH AVE (PEDIATRIC OFFICE BUILDING) ATTN 5TH FLOOR NUTRITION
PENSACOLA FL
32504-8785
US

IV. Provider business mailing address

PO BOX 2699 SHMG/HPE
PENSACOLA FL
32513-2699
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-1026
  • Fax: 850-416-6142
Mailing address:
  • Phone: 850-416-1026
  • Fax: 850-416-6142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberND8456
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: