Provider Demographics
NPI:1154433647
Name:PEIRCE, CAROL PATRICIA (MS, RD, LD/N)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:PATRICIA
Last Name:PEIRCE
Suffix:
Gender:F
Credentials:MS, RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 SW MELBOURNE ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-5955
Mailing Address - Country:US
Mailing Address - Phone:772-879-6168
Mailing Address - Fax:772-879-2326
Practice Address - Street 1:4015 SW MELBOURNE ST
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-5955
Practice Address - Country:US
Practice Address - Phone:772-879-6168
Practice Address - Fax:772-879-2326
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL133VOOOOOX133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL644547OtherAMERICAN DIETETIC ASSOCIA