Provider Demographics
NPI:1366102733
Name:SAMANTHA CARTINA RD
Entity type:Organization
Organization Name:SAMANTHA CARTINA RD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:CARTINA
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LD/N, CNSC
Authorized Official - Phone:904-345-0586
Mailing Address - Street 1:8599 A C SKINNER PKWY UNIT 2308
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0858
Mailing Address - Country:US
Mailing Address - Phone:815-341-3220
Mailing Address - Fax:904-372-1977
Practice Address - Street 1:115 CEDARDEL ST
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60051-9710
Practice Address - Country:US
Practice Address - Phone:904-345-0586
Practice Address - Fax:904-372-1977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-27
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty