Provider Demographics
NPI:1548345564
Name:TISCARENO, FLORENCE ANN (RD)
Entity type:Individual
Prefix:
First Name:FLORENCE
Middle Name:ANN
Last Name:TISCARENO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 OAK HILLS CIR APT 38
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-4223
Mailing Address - Country:US
Mailing Address - Phone:925-261-1824
Mailing Address - Fax:
Practice Address - Street 1:101 BODIN CIR
Practice Address - Street 2:60TH MDG/60MDTS/SGQD DAVID GRANT MEDICAL CENTER
Practice Address - City:TRAVIS AFB
Practice Address - State:CA
Practice Address - Zip Code:94535-1809
Practice Address - Country:US
Practice Address - Phone:707-423-3668
Practice Address - Fax:707-423-3627
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered