Healthcare Provider Details

I. General information

NPI: 1821149113
Provider Name (Legal Business Name): JENNIFER BRODER KATZ RD, LD,N,CNSD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 NORMANDY TRACE RD
TAMPA FL
33602-5777
US

IV. Provider business mailing address

1013 NORMANDY TRACE RD
TAMPA FL
33602-5777
US

V. Phone/Fax

Practice location:
  • Phone: 813-857-2520
  • Fax:
Mailing address:
  • Phone: 813-857-2520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberND3660
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberND3660
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND3660
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberND3660
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: