Provider Demographics
NPI:1861222523
Name:TOIVOLA, AMANDA M (MS, RD, LD/N, CLC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:TOIVOLA
Suffix:
Gender:F
Credentials:MS, RD, LD/N, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12311 KENSINGTON LAKES DR UNIT 1404
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-1366
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12311 KENSINGTON LAKES DR UNIT 1404
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-1366
Practice Address - Country:US
Practice Address - Phone:770-708-2962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND10567133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered