MEDICARE: JEANNA L RHOULHAC RD LDN CDE

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	133N00000X	Nutritionist	ND1730	FL

General Provider Information

NPI Number	:	1881658755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNA L RHOULHAC RD LDN CDE

Provider Business Mailing Address
First Line	:	1700 NW 49TH ST STE 125
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-3750
Country	:	US
Telephone Number	:	954-463-7313
Fax Number	:	954-527-6082

Provider Business Practice Location Address
First Line	:	1111 W BROWARD BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-1638
Country	:	US
Telephone Number	:	954-463-7313
Fax Number	:	954-527-6082

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

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	07/29/2022

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