Provider Demographics
NPI:1558109892
Name:RUGGIO, LAURA BETH (RDN, LDN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:BETH
Last Name:RUGGIO
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 VILLAGE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-3876
Mailing Address - Country:US
Mailing Address - Phone:904-240-0442
Mailing Address - Fax:
Practice Address - Street 1:201 VILLAGE OAKS DR
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-3876
Practice Address - Country:US
Practice Address - Phone:904-240-0442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-19
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND13398133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered