MEDICARE: MS. KAREN ELAINE DUFFY REGISTERED DIETITIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	ND2761	FL

General Provider Information

NPI Number	:	1154303030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAREN ELAINE DUFFY REGISTERED DIETITIAN

Provider Business Mailing Address
First Line	:	111 NATURE WALK PKWY
Second Line	:	SUITE 106
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32092-5073
Country	:	US
Telephone Number	:	904-599-7177
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 NATURE WALK PKWY
Second Line	:	SUITE 106
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32092-5073
Country	:	US
Telephone Number	:	904-599-7177
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	03/19/2008

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