Healthcare Provider Details

I. General information

NPI: 1659905016
Provider Name (Legal Business Name): ERIKA COOK RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIKA LYNN BAUERBAND

II. Dates (important events)

Enumeration Date: 02/25/2020
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 SEA OAKS DR
ST AUGUSTINE FL
32080-7914
US

IV. Provider business mailing address

7 SEA OAKS DR
ST AUGUSTINE FL
32080-7914
US

V. Phone/Fax

Practice location:
  • Phone: 904-894-1592
  • Fax:
Mailing address:
  • Phone: 904-894-1592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License NumberND7072
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberND7072
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code133VN1301X
TaxonomyOncology Nutrition Registered Dietitian
License NumberND7072
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: