Individual
KRISTINE ANN VAN WORKUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, LDN
Contact information
Practice address
1223 GATEWAY DR STE 2B, MELBOURNE, FL 32901-2607
(321) 725-4500
(321) 727-0975
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
ND 5470
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IK418Z
FL MEDICARE
FL
05
—
PENDING
—
FL
Enumeration date
08/21/2006
Last updated
03/16/2020
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