Provider Demographics
NPI:1720793623
Name:PATRICK, ELIZABETH BRYANT (RDN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BRYANT
Last Name:PATRICK
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:709 EMMA ST APT 1
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-7390
Mailing Address - Country:US
Mailing Address - Phone:786-647-9622
Mailing Address - Fax:
Practice Address - Street 1:5900 COLLEGE RD
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4342
Practice Address - Country:US
Practice Address - Phone:305-294-5531
Practice Address - Fax:305-292-3942
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8916133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered