| Doctor Name: | MRS. TAMMY ALVAREZ WIEDEMAN |
| NPI Number: | 1265643019 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RD, LD,N |
| License Number: | ND4613 |
| Business Practice Address: | 3100 University Blvd S Suite 220 Jacksonville, FL - 322162758 |
| Business Phone Number: | 9047242043 |
| Business Fax Number: | |
| Mailing Address: | 1076 Featherwood Ct, ATLANTIC BEACH |
| State: | FL |
| Postal Code: | 322336913 |
| Phone Number: | 9042475588 |
| Fax Number: | |
| NPI Enumeration Date: | 05/24/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | ND4613 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |