Basic Information
| Provider Information | |||||||||
| NPI: | 1366102733 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAMANTHA CARTINA RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8599 A C SKINNER PKWY UNIT 2308 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322560858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153413220 | ||||||||
| FaxNumber: | 9043721977 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 CEDARDEL ST | ||||||||
| Address2: | |||||||||
| City: | MCHENRY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600519710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043450586 | ||||||||
| FaxNumber: | 9043721977 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2021 | ||||||||
| LastUpdateDate: | 03/08/2022 | ||||||||
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| AuthorizedOfficialLastName: | CARTINA | ||||||||
| AuthorizedOfficialFirstName: | SAMANTHA | ||||||||
| AuthorizedOfficialMiddleName: | MARIA | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9043450586 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RDN, LD/N, CNSC | ||||||||
| NPICertificationDate: | 03/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.