Jennifer Mimkha, MPH RD LDN CLC CLT

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

ND6949 Issued in FL

Practice address

11850 Dr Martin Luther King St N Apt 12304
Saint Petersburg, FL 33716-1631

Phone

(484) 620-2785

NPI assigned

Oct 26, 2018

Last updated

Oct 26, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Jennifer Stafford Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1540512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540512000000",
    "number": "1558838672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11850 DR MARTIN LUTHER KING ST N APT 12304",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337161631",
            "telephone_number": "484-620-2785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11850 DR MARTIN LUTHER KING ST N APT 12304",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337161631",
            "telephone_number": "484-620-2785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIMKHA",
        "first_name": "JENNIFER",
        "credential": "MPH RD LDN CLC CLT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-10-26",
        "last_updated": "2018-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "FL",
            "license": "ND6949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "STAFFORD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Diana Milojevic, M.D.
• Carolina Milosescu
• Alex C Milov, LMHC
• Dagmar Weber Milroy, M.A., CCC-SLP
• Adrian Milton
• Mims Sitter Service, Inc
• Mind & Body Clinic Corp
• Mind and Mouth
• Mind Body Foundations OT, LLC
• Mind Body Wellness Group LLC

• Registered Dietitian in St Petersburg, FL
• Providers in St Petersburg, FL by specialty
• Registered Dietitian in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2018; 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.