Provider Demographics
NPI:1871163949
Name:GILPIN, MASSIEL IRENE (RD)
Entity type:Individual
Prefix:
First Name:MASSIEL
Middle Name:IRENE
Last Name:GILPIN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MASSIEL
Other - Middle Name:IRENE
Other - Last Name:GERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1600 LAKELAND HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3019
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1755 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3109
Practice Address - Country:US
Practice Address - Phone:863-680-7490
Practice Address - Fax:866-264-8519
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND9914133V00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered