Provider Demographics
NPI:1164382693
Name:KRETZMER, RAE
Entity type:Individual
Prefix:
First Name:RAE
Middle Name:
Last Name:KRETZMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 S BLUE ANGEL PKWY APT 736
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-6149
Mailing Address - Country:US
Mailing Address - Phone:860-818-1804
Mailing Address - Fax:
Practice Address - Street 1:2600 S BLUE ANGEL PKWY APT 736
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-6149
Practice Address - Country:US
Practice Address - Phone:860-818-1804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-17
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14564133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty