Provider Demographics
NPI:1316921851
Name:HOOKER, ELLEN M (RD CDE)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:HOOKER
Suffix:
Gender:F
Credentials:RD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 5TH AVE NORTH
Mailing Address - Street 2:STE 302
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1457
Mailing Address - Country:US
Mailing Address - Phone:727-821-2388
Mailing Address - Fax:727-821-6887
Practice Address - Street 1:1201 5TH AVE NORTH
Practice Address - Street 2:STE 302
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1457
Practice Address - Country:US
Practice Address - Phone:727-821-2388
Practice Address - Fax:727-821-6887
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND613133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLN0187OtherBLUE SHIELD OF FLORIDA
P00126506OtherRAILROAD RETIREMENT MEDIC
FLE6889Medicare ID - Type Unspecified