Individual
MRS. LAURA M. JACONETTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, LDN
Contact information
Practice address
1000 36TH ST, VERO BEACH, FL 32960-4862
(772) 567-4311
Mailing address
3681 DURKSLY DR, MELBOURNE, FL 32940-1338
(615) 495-5358
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
ND11487
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ND11487
STATE OF FLORIDA DEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE
FL
Enumeration date
09/01/2023
Last updated
09/01/2023
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