MEDICARE: GLUCOTRITION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133VN1006X	Metabolic Nutrition Registered Dietitian

General Provider Information

NPI Number	:	1902762859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLUCOTRITION

Provider Business Mailing Address
First Line	:	1616 CAPE CORAL PKWY W STE 102
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-8911
Country	:	US
Telephone Number	:	239-469-0866
Fax Number	:

Provider Business Practice Location Address
First Line	:	4417 AGUALINDA BLVD
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-6211
Country	:	US
Telephone Number	:	239-469-0866
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEPHANIE FRY
Credential	:	RN, RD, LDN
Telephone Number	:	239-469-0866

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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Directions to “GLUCOTRITION ” Practice Location

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