Provider Demographics
NPI:1962939249
Name:HOANG, JENNIFER T (RDN, LD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:T
Last Name:HOANG
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5908 SILVER ROCK LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76135-5304
Mailing Address - Country:US
Mailing Address - Phone:817-487-7788
Mailing Address - Fax:
Practice Address - Street 1:10864 TEXAS HEALTH TRL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-4897
Practice Address - Country:US
Practice Address - Phone:817-487-7788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT84631133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered