Provider Demographics
NPI:1144305392
Name:ALSUP, BLAIR SKINNER (RD, LD/N)
Entity type:Individual
Prefix:MRS
First Name:BLAIR
Middle Name:SKINNER
Last Name:ALSUP
Suffix:
Gender:F
Credentials:RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 WRENCREST CIR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-6319
Mailing Address - Country:US
Mailing Address - Phone:813-657-7609
Mailing Address - Fax:
Practice Address - Street 1:4555 S MANHATTAN AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-2305
Practice Address - Country:US
Practice Address - Phone:813-839-6341
Practice Address - Fax:813-837-0721
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4083133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered