Healthcare Provider Details

I. General information

NPI: 1760069629
Provider Name (Legal Business Name): NUTRITION OF EVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13166 ODYSSEY LAKE WAY
ORLANDO FL
32826-4642
US

IV. Provider business mailing address

13166 ODYSSEY LAKE WAY
ORLANDO FL
32826-4642
US

V. Phone/Fax

Practice location:
  • Phone: 407-455-8258
  • Fax:
Mailing address:
  • Phone: 407-455-8258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: LACIE L BRISBON
Title or Position: CERTIFIED HOLISTIC NUTRITIONIST CEO
Credential:
Phone: 407-455-8258