Provider Demographics
NPI:1679156764
Name:MERRITT, JENNIE (RDN)
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:MERRITT
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 SAVANNA PALMS CT
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-2472
Mailing Address - Country:US
Mailing Address - Phone:571-244-6073
Mailing Address - Fax:
Practice Address - Street 1:4120 SAVANNA PALMS CT
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-2472
Practice Address - Country:US
Practice Address - Phone:571-244-6073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2024-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND11169133VN1101X
839145133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1101XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Gerontological