Provider Demographics
NPI:1699934794
Name:BOROW, BERNICE ANN (RD)
Entity type:Individual
Prefix:
First Name:BERNICE
Middle Name:ANN
Last Name:BOROW
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7062 KINGSMILL CT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5193
Mailing Address - Country:US
Mailing Address - Phone:914-682-1735
Mailing Address - Fax:914-686-5228
Practice Address - Street 1:7062 KINGSMILL CT
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5193
Practice Address - Country:US
Practice Address - Phone:914-682-1735
Practice Address - Fax:914-686-5228
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006523-1133V00000X, 133VN1004X
FLND 5917133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric