Provider Demographics
NPI:1093017923
Name:FUNK, PATRICIA JEAN (MS, RD, LDN,)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:JEAN
Last Name:FUNK
Suffix:
Gender:F
Credentials:MS, RD, LDN,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 SW ARCHER RD
Mailing Address - Street 2:PO BOX 100325
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-3003
Mailing Address - Country:US
Mailing Address - Phone:352-265-0400
Mailing Address - Fax:352-265-1071
Practice Address - Street 1:2000 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1136
Practice Address - Country:US
Practice Address - Phone:352-265-0400
Practice Address - Fax:352-265-1071
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-29
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND985133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered