Provider Demographics
NPI:1730192220
Name:TUCKER, ELIZABETH LANIUS (RD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LANIUS
Last Name:TUCKER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:TUCKER
Other - Last Name:GRAFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:597 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-2330
Mailing Address - Country:US
Mailing Address - Phone:850-252-9656
Mailing Address - Fax:850-462-6200
Practice Address - Street 1:597 W 11TH ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2330
Practice Address - Country:US
Practice Address - Phone:850-252-9656
Practice Address - Fax:850-462-6200
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1010133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered