Provider Demographics
NPI:1053616524
Name:ARENA, MARISA (RD)
Entity type:Individual
Prefix:MS
First Name:MARISA
Middle Name:
Last Name:ARENA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4519 TILTON CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1214
Mailing Address - Country:US
Mailing Address - Phone:239-494-8739
Mailing Address - Fax:239-494-8752
Practice Address - Street 1:4519 TILTON CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1214
Practice Address - Country:US
Practice Address - Phone:239-494-8739
Practice Address - Fax:239-494-8752
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4225133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered