MEDICARE: MRS. EMILY K BRANTLEY RDN, LD/N, CDCES

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	ND7181	FL

General Provider Information

NPI Number	:	1902283732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EMILY K BRANTLEY RDN, LD/N, CDCES

Provider Business Mailing Address
First Line	:	12482 MOUNT PLEASANT WOODS DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-2678
Country	:	US
Telephone Number	:	904-477-8790
Fax Number	:

Provider Business Practice Location Address
First Line	:	12482 MOUNT PLEASANT WOODS DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-2678
Country	:	US
Telephone Number	:	904-477-8790
Fax Number	:

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

Provider Enumeration Date	:	04/30/2015
Last Update Date	:	03/17/2026

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