Provider Demographics
NPI:1033096094
Name:VAN ZWIETEN, KATHRYN (CNS, LDN)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:VAN ZWIETEN
Suffix:
Gender:F
Credentials:CNS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11141
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32302-3141
Mailing Address - Country:US
Mailing Address - Phone:407-417-4630
Mailing Address - Fax:
Practice Address - Street 1:3208 TALON CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-7258
Practice Address - Country:US
Practice Address - Phone:407-417-4630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14484133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist