Provider Demographics
NPI:1235929548
Name:WATERS, ALAINA GRACE (RD, LD)
Entity type:Individual
Prefix:
First Name:ALAINA
Middle Name:GRACE
Last Name:WATERS
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7651 GATE PKWY APT 609
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4804
Mailing Address - Country:US
Mailing Address - Phone:912-678-5316
Mailing Address - Fax:
Practice Address - Street 1:7651 GATE PKWY APT 609
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-4804
Practice Address - Country:US
Practice Address - Phone:912-678-5316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD006579133V00000X
MS2558133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered