Individual
NICOLE DEROSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
1210 E PLANT ST STE 130, WINTER GARDEN, FL 34787-2995
(407) 297-8408
Mailing address
249 ALFORD DR, DAVENPORT, FL 33896-8396
(203) 560-4039
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
ND8682
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86077693
COMMISSION OF DIETETIC REGISTRATION
—
01
—
ND8682
FLORIDA DEPARTMENT OF HEALTH
FL
Enumeration date
02/13/2019
Last updated
02/13/2019
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