Provider Demographics
NPI:1518786813
Name:PHIFER, JOSIE ELIZABETH
Entity type:Individual
Prefix:
First Name:JOSIE
Middle Name:ELIZABETH
Last Name:PHIFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 VALENCIA RD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2538
Mailing Address - Country:US
Mailing Address - Phone:941-685-0502
Mailing Address - Fax:
Practice Address - Street 1:604 VALENCIA RD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2538
Practice Address - Country:US
Practice Address - Phone:941-685-0502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-04
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10780133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered