Healthcare Provider Details

I. General information

NPI: 1346401510
Provider Name (Legal Business Name): THE BEACHED WHALE SWIMS PL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6050 SAINT JOHNS AVE SUITE 8
PALATKA FL
32177-6860
US

IV. Provider business mailing address

PO BOX 1657
INTERLACHEN FL
32148-1657
US

V. Phone/Fax

Practice location:
  • Phone: 386-546-5732
  • Fax: 888-391-3648
Mailing address:
  • Phone: 386-546-5732
  • Fax: 888-391-3648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberND2522
License Number StateFL

VIII. Authorized Official

Name: MS. HELEN LOUISE CURTIS
Title or Position: OWNER/CONSULTANT
Credential: RD LDN CDE
Phone: 386-546-5732