Individual
JEANNE FARRELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, CNSC
Contact information
Practice address
501 6TH AVE S, ST PETERSBURG, FL 33701-4634
(727) 767-8419
Mailing address
205 TIDAL LN APT 104, BRADENTON, FL 34212-4446
(727) 767-8419
Taxonomy
Speciality
Code
Description
License number
State
133VN1004X
Pediatric Nutrition Registered Dietitian
Primary
ND1271
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
652804
—
FL
Enumeration date
10/02/2014
Last updated
10/03/2014
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