Healthcare Provider Details

I. General information

NPI: 1992934368
Provider Name (Legal Business Name): NUTRITION THERAPY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 07/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3221 NW 13TH ST STE D2
GAINESVILLE FL
32609-2189
US

IV. Provider business mailing address

3221 NW 13TH ST STE D2
GAINESVILLE FL
32609-2189
US

V. Phone/Fax

Practice location:
  • Phone: 352-371-8181
  • Fax:
Mailing address:
  • Phone: 352-371-8181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberND 2798
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND2798
License Number StateFL

VIII. Authorized Official

Name: KARIN KRATINA
Title or Position: DIRECTOR
Credential: PHD, RD, LD/N
Phone: 352-371-8181