Provider Demographics
NPI:1033342209
Name:JOHN, LEANN ELIZABETH (MS, RD, LDN)
Entity type:Individual
Prefix:MS
First Name:LEANN
Middle Name:ELIZABETH
Last Name:JOHN
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1347 AZALEA DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-8357
Mailing Address - Country:US
Mailing Address - Phone:814-322-5620
Mailing Address - Fax:
Practice Address - Street 1:1347 AZALEA DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-8357
Practice Address - Country:US
Practice Address - Phone:814-322-5620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-03
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5744133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered