Healthcare Provider Details

I. General information

NPI: 1649528118
Provider Name (Legal Business Name): HEATHER ELAINE HUFFMAN RD, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97185 CASTLE RIDGE DR
YULEE FL
32097-5064
US

IV. Provider business mailing address

97185 CASTLE RIDGE DR
YULEE FL
32097-5064
US

V. Phone/Fax

Practice location:
  • Phone: 904-838-0870
  • Fax:
Mailing address:
  • Phone: 904-838-0870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND3845
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: