Provider Demographics
NPI:1548149008
Name:VINCENT, ALYSSA MARIE (RD, LD/N)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MARIE
Last Name:VINCENT
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 1:4980 CABANA CT
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33812-4490
Mailing Address - Country:US
Mailing Address - Phone:330-417-2978
Mailing Address - Fax:
Practice Address - Street 1:4980 CABANA CT
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33812-4490
Practice Address - Country:US
Practice Address - Phone:330-417-2978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5896133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered