Active NPI
Elise Fenstermaker, RD
- Registered Dietitian
- Jacksonville, FL
National Provider Identifier
1114230190
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- ND 5534
- Practice address
- 5150 Timuquana Rd
Jacksonville, FL 32210-8959 - Phone
- (904) 253-2359
- NPI assigned
- Jul 20, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | ND 5534 | FL | Primary |
Addresses
Primary practice location
5150 Timuquana Rd
Jacksonville, FL 32210-8959
Mailing address
900 University Blvd N
#606
Jacksonville, FL 32211-9230
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ND 5534 | FL | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1279584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1279584000000",
"number": "1114230190",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 UNIVERSITY BLVD N",
"address_2": "#606",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322119230"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5150 TIMUQUANA RD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322108959",
"telephone_number": "904-253-2359"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FENSTERMAKER",
"first_name": "ELISE",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-07-20",
"last_updated": "2010-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "FL",
"license": "ND 5534",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.