Provider Demographics
NPI:1184512501
Name:HART, MARY CATHERINE (RD/LDN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:HART
Suffix:
Gender:F
Credentials:RD/LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1679 PATRICIA LN
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2837
Mailing Address - Country:US
Mailing Address - Phone:443-504-4599
Mailing Address - Fax:
Practice Address - Street 1:1679 PATRICIA LN
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-2837
Practice Address - Country:US
Practice Address - Phone:443-504-4599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND14211133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered