MEDICARE: MRS. CAROL H JENNINGS MPH RD LD

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	ND00002001	FL

General Provider Information

NPI Number	:	1457342115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROL H JENNINGS MPH RD LD

Provider Business Mailing Address
First Line	:	PO BOX 612
Second Line	:
City	:	SAN ANTONIO
State	:	FL
Zip	:	33576-0612
Country	:	US
Telephone Number	:	352-588-0963
Fax Number	:

Provider Business Practice Location Address
First Line	:	7050 GALL BLVD
Second Line	:	EAST PASCO MEDICAL CENTER
City	:	ZEPHYRHILLS
State	:	FL
Zip	:	33541-1347
Country	:	US
Telephone Number	:	813-744-0411
Fax Number	:

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	07/08/2007

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