MEDICARE: ELIZABETH TABBOUCHE

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	ND14770	FL

General Provider Information

NPI Number	:	1386506178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH TABBOUCHE

Provider Business Mailing Address
First Line	:	5800 LAKESHORE DR APT 318
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-6621
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5800 LAKESHORE DR APT 318
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-6621
Country	:	US
Telephone Number	:	551-804-4617
Fax Number	:

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

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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