Healthcare Provider Details

I. General information

NPI: 1942649736
Provider Name (Legal Business Name): CHERYL ELAINE TIBBITTS R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHERYL ELAINE OHRMUND

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13330 USF LAUREL DR
TAMPA FL
33612-6601
US

IV. Provider business mailing address

PO BOX 917770
ORLANDO FL
32891-0001
US

V. Phone/Fax

Practice location:
  • Phone: 813-821-8038
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number84520634901
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1095153
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND12481
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: