MEDICARE: JANTELLE EILEEN QUIGLEY RDN, LDN

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	10932	FL

General Provider Information

NPI Number	:	1558148700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANTELLE EILEEN QUIGLEY RDN, LDN

Provider Business Mailing Address
First Line	:	3672 TORRE GRANDE AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-6941
Country	:	US
Telephone Number	:	228-223-7247
Fax Number	:

Provider Business Practice Location Address
First Line	:	3672 TORRE GRANDE AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-6941
Country	:	US
Telephone Number	:	228-223-7247
Fax Number	:

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

Provider Enumeration Date	:	09/12/2023
Last Update Date	:	09/12/2023

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