Provider Demographics
NPI:1598576332
Name:BERNARDON, CAROLINE (RDN)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:BERNARDON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 CHANNELSIDE DR # A905
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5476
Mailing Address - Country:US
Mailing Address - Phone:908-251-0286
Mailing Address - Fax:
Practice Address - Street 1:545 CHANNELSIDE DR # A905
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-5476
Practice Address - Country:US
Practice Address - Phone:908-251-0286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13851133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered