=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316455736
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARLA JEAN DANESI RD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2018
-----------------------------------------------------
Last Update Date | 03/06/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5382 SPRING HILL DR
-----------------------------------------------------
City | SPRING HILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34606-4562
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-200-2190
-----------------------------------------------------
Fax | 352-200-2191
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14690 SPRING HILL DR STE 305
-----------------------------------------------------
City | SPRING HILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34609-8102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-277-5348
-----------------------------------------------------
Fax | 352-606-2857
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | ND6546
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------