Healthcare Provider Details

I. General information

NPI: 1477653400
Provider Name (Legal Business Name): BARBARA M MAHLMEISTER NUTRITIONALIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 10/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4114 PINELAKE LN
TAMPA FL
33618-8656
US

IV. Provider business mailing address

4114 PINELAKE LN
TAMPA FL
33618-8656
US

V. Phone/Fax

Practice location:
  • Phone: 813-495-2719
  • Fax: 813-960-0802
Mailing address:
  • Phone: 813-495-2719
  • Fax: 813-960-0802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberND 4668
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: