Provider Demographics
NPI:1760227102
Name:BECKER, JANE ELIZABETH (RDN, LDN)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:ELIZABETH
Last Name:BECKER
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30115 STATE ROAD 52
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN ANTONIO
Mailing Address - State:FL
Mailing Address - Zip Code:33576
Mailing Address - Country:US
Mailing Address - Phone:352-437-5971
Mailing Address - Fax:
Practice Address - Street 1:30115 COUNTY ROAD 52
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:FL
Practice Address - Zip Code:33576-8244
Practice Address - Country:US
Practice Address - Phone:352-437-5971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4203133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered