Provider Demographics
NPI:1063903664
Name:CREGO, ZOE MARIE (RD, LD/N)
Entity type:Individual
Prefix:
First Name:ZOE
Middle Name:MARIE
Last Name:CREGO
Suffix:
Gender:F
Credentials:RD, LD/N
Other - Prefix:
Other - First Name:ZOE
Other - Middle Name:MARIE
Other - Last Name:TABOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1459 SW 16TH TER
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-4118
Mailing Address - Country:US
Mailing Address - Phone:321-271-9499
Mailing Address - Fax:
Practice Address - Street 1:2950 CLEVELAND CLINIC BLVD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3609
Practice Address - Country:US
Practice Address - Phone:954-487-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-20
Last Update Date:2018-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND8498133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered