MEDICARE: ALYSSA COOKE 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	ND9735	FL

General Provider Information

NPI Number	:	1255283727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA COOKE RD

Provider Business Mailing Address
First Line	:	4108 GEORGE RD UNIT 2512
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-7576
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4108 GEORGE RD UNIT 2512
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-7576
Country	:	US
Telephone Number	:	860-418-7959
Fax Number	:

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

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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Directions to “ ALYSSA COOKE RD” Practice Location

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