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General NPI Number Information
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NPI Number | 1013173707
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Entity Type | Individual
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Provider Name | TANYA RENEE LUNSFORD RD
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Gender | Female
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Dates
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Enumeration Date | 08/01/2008
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Last Update Date | 05/07/2026
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Provider Practice Location Address
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Address Line | 115 MIRACLE STRIP PKWY SE UNIT 204
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-6018
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Country | US
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Telephone | 850-374-7604
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Fax |
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Provider Business Mailing Address
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Address Line | 1559 INGLE RD STE A
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City | DEFUNIAK SPRINGS
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State | FL
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Zip | 32433-5065
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Country | US
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Telephone | 812-592-4061
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | ND14079
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 836192
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 3700100A
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License Number State | IN
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