Individual
TINA MARIE ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD,LDN, MPH, CDE
Contact information
Practice address
501 DEL PRADO BLVD S, CAPE CORAL, FL 33990-2618
(239) 424-3120
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 424-3120
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
ND11044
FL
133NN1002X
Nutrition Education Nutritionist
ND11044
FL
133V00000X
Registered Dietitian
164.000203
IL
133V00000X
Registered Dietitian
ND11044
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
125197700
—
FL
Enumeration date
11/19/2014
Last updated
01/27/2025
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