Provider Demographics
NPI:1003790163
Name:ENCARNACION, CHRISTINA (RD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:ENCARNACION
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3780 OLD BERRY PT APT 311
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-9547
Mailing Address - Country:US
Mailing Address - Phone:321-536-8636
Mailing Address - Fax:
Practice Address - Street 1:2310 N AIRPORT RD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1426
Practice Address - Country:US
Practice Address - Phone:239-931-8401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-02
Last Update Date:2025-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND11459133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered