Provider Demographics
NPI:1699577403
Name:FRICKE, LIA MARIE (MS RD LDN)
Entity type:Individual
Prefix:
First Name:LIA
Middle Name:MARIE
Last Name:FRICKE
Suffix:
Gender:
Credentials:MS RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 WATER ST APT B1709
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5412
Mailing Address - Country:US
Mailing Address - Phone:816-510-3996
Mailing Address - Fax:
Practice Address - Street 1:815 WATER ST APT B1709
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-5412
Practice Address - Country:US
Practice Address - Phone:816-510-3996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND14108133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty