Provider Demographics
NPI:1043548431
Name:ABDELNOUR, JANICE RIDDELL (RD, CDE)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:RIDDELL
Last Name:ABDELNOUR
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:PATRICIA
Other - Last Name:RIDDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:820 PRUDENTIAL DR
Mailing Address - Street 2:SUITE 416
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8210
Mailing Address - Country:US
Mailing Address - Phone:904-202-2140
Mailing Address - Fax:904-202-2462
Practice Address - Street 1:820 PRUDENTIAL DR
Practice Address - Street 2:SUITE 416
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8210
Practice Address - Country:US
Practice Address - Phone:904-202-2140
Practice Address - Fax:904-202-2462
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND141133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered