Individual
ANISSA LYNN BOURGEACQ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDN
Contact information
Practice address
8221 SANDPOINT BLVD, ORLANDO, FL 32819-7252
(319) 855-0415
Mailing address
8221 SANDPOINT BLVD, ORLANDO, FL 32819-7252
(319) 855-0415
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
ND10630
FL
Other
Enumeration date
07/04/2022
Last updated
07/04/2022
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