Healthcare Provider Details

I. General information

NPI: 1316087406
Provider Name (Legal Business Name): AMY FOSTER MAGNUSON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 LEARNING WAY
TALLAHASSEE FL
32306-4178
US

IV. Provider business mailing address

960 LEARNING WAY
TALLAHASSEE FL
32306-4178
US

V. Phone/Fax

Practice location:
  • Phone: 850-644-6230
  • Fax: 850-644-4251
Mailing address:
  • Phone: 850-644-6230
  • Fax: 850-644-4251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND3244
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: