Provider Demographics
NPI:1699545152
Name:WAUGAMAN, MERCEDES (MS, RDN, LDN)
Entity type:Individual
Prefix:
First Name:MERCEDES
Middle Name:
Last Name:WAUGAMAN
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5268 TALLULAH LAKE CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-0831
Mailing Address - Country:US
Mailing Address - Phone:904-382-2228
Mailing Address - Fax:
Practice Address - Street 1:1200 RIVERPLACE BLVD STE 1051218
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-9046
Practice Address - Country:US
Practice Address - Phone:904-382-2228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND12737133VN1201X, 133V00000X, 133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric