Provider Demographics
NPI:1710865043
Name:BAEZ, JANNELL ELAINE (RD, LD/N)
Entity type:Individual
Prefix:MRS
First Name:JANNELL
Middle Name:ELAINE
Last Name:BAEZ
Suffix:
Gender:X
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 1:5731 SW 111 TERR
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-6306
Mailing Address - Country:US
Mailing Address - Phone:305-310-7554
Mailing Address - Fax:
Practice Address - Street 1:1930 HARRISON ST STE 404
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-7829
Practice Address - Country:US
Practice Address - Phone:786-780-1188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4237133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered