MEDICARE: JACQUELINE RIER RD

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	ND12473	FL

General Provider Information

NPI Number	:	1255221321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE RIER RD

Provider Business Mailing Address
First Line	:	500 TRINITY LN N APT 3214
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33716-1226
Country	:	US
Telephone Number	:	641-420-5617
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 TRINITY LN N APT 3214
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33716-1226
Country	:	US
Telephone Number	:	641-420-5617
Fax Number	:

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

Provider Enumeration Date	:	07/08/2025
Last Update Date	:	07/08/2025

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