Jenna Taylor Braddock, RD, LDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

ND 4851 Issued in FL

Practice address

3100 University Blvd S
Suite 220
Jacksonville, FL 32216-2758

Phone

(904) 724-2043

Fax

(904) 724-2013

NPI assigned

Jun 12, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Medical Nutrition Therapy of Florida, Inc.

  • Registered Dietitian
  • Jacksonville, FL
  • NPI 1871600700

  Dietitian, Registered

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1326242520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "947 SCRUB JAY DR",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320921759",
            "telephone_number": "904-810-0368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 UNIVERSITY BLVD S",
            "address_2": "SUITE 220",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322162758",
            "telephone_number": "904-724-2043",
            "fax_number": "904-724-2013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADDOCK",
        "first_name": "JENNA",
        "middle_name": "TAYLOR",
        "credential": "RD, LDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "FL",
            "license": "ND 4851",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lacey Dennis Bracken, MS,LAT,ATC
• Timika Shenay Bracken, NP
• Rachel Brackenridge, LCSW
• Linh Truong Bradberry, DMD
• Timothy Bradberry, DMD
• Jessica Ann Braddock
• Kathryn Braddock, ARNP
• Matthew Todd Braddock, D.O.
• Kathryn Braddy-Dillard, APRN-CNP
• Teresa Braddy, R.N.

• Registered Dietitian in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Registered Dietitian in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.