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General NPI Number Information
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NPI Number | 1235536293
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Entity Type | Individual
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Provider Name | TINA MARIE ANDERSON RD,LDN, MPH, CDE
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Gender | Female
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Dates
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Enumeration Date | 11/19/2014
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 501 DEL PRADO BLVD S
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City | CAPE CORAL
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State | FL
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Zip | 33990-2618
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Country | US
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Telephone | 239-424-3120
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2147
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City | FORT MYERS
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State | FL
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Zip | 33902-2147
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Country | US
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Telephone | 239-424-3120
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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 | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number | ND11044
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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 | 164.000203
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License Number State | IL
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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 | ND11044
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | ND11044
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License Number State | FL
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