Healthcare Provider Details

I. General information

NPI: 1962286039
Provider Name (Legal Business Name): JENNIFER MANN NUTRITION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 W BROWARD BLVD STE 203
FORT LAUDERDALE FL
33312-1315
US

IV. Provider business mailing address

9553 FOX TROT LN
BOCA RATON FL
33496-4107
US

V. Phone/Fax

Practice location:
  • Phone: 954-787-2554
  • Fax: 954-678-2590
Mailing address:
  • Phone: 954-592-0337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER MANN
Title or Position: OWNER
Credential: RD
Phone: 954-592-0337