Healthcare Provider Details

I. General information

NPI: 1811120116
Provider Name (Legal Business Name): CHRIS MARTIN ZAWISZA RD, CDE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 05/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 W DR MARTIN LUTHER KING JR BLVD SUITE 800
TAMPA FL
33607-6383
US

IV. Provider business mailing address

2727 W DR MARTIN LUTHER KING JR BLVD SUITE 800
TAMPA FL
33607-6383
US

V. Phone/Fax

Practice location:
  • Phone: 813-873-0000
  • Fax: 813-873-3659
Mailing address:
  • Phone: 813-873-0000
  • Fax: 813-873-3659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND3645
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberND3645
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: