Active NPI
Anissa Lynn Bourgeacq, RDN
- Registered Dietitian
- Orlando, FL
National Provider Identifier
1164155578
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- ND10630
- Practice address
- 8221 Sandpoint Blvd
Orlando, FL 32819-7252 - Phone
- (319) 855-0415
- NPI assigned
- Jul 4, 2022
- Last updated
- Jul 4, 2022
- Sex
- Female
- Sole proprietor
- No
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 | ND10630 | FL | Primary |
Addresses
Primary practice location
8221 Sandpoint Blvd
Orlando, FL 32819-7252
Mailing address
8221 Sandpoint Blvd
Orlando, FL 32819-7252
Phone (319) 855-0415
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ND10630 | FL | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Focus Dietetics | Dietitian, Registered | Current | Accepting new patients |
| Mochi Medical Ca PC | Past | Accepting new patients | |
| Allara Medical Group PA | Past | Accepting new patients | |
| Marjorie Nolan Cohn LLC | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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- NPI 1174303374
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1656892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656892800000",
"number": "1164155578",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8221 SANDPOINT BLVD",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328197252",
"telephone_number": "319-855-0415"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8221 SANDPOINT BLVD",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328197252",
"telephone_number": "319-855-0415"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOURGEACQ",
"first_name": "ANISSA",
"middle_name": "LYNN",
"credential": "RDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-07-04",
"last_updated": "2022-07-04",
"certification_date": "2022-07-04",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "FL",
"license": "ND10630",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orlando, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.