Individual
JEROME FOSAAEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RD, LD/N
Contact information
Practice address
1605 SANTA MARIE CT, SAINT AUGUSTINE, FL 32080-5478
(904) 417-7344
Mailing address
1605 SANTA MARIE CT, SAINT AUGUSTINE, FL 32080-5478
(904) 417-7344
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
ND4527
FL
Other
Enumeration date
12/05/2014
Last updated
12/05/2014
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