Healthcare Provider Details

I. General information

NPI: 1003305053
Provider Name (Legal Business Name): SOUTH FLORIDA NUTRITION CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2018
Last Update Date: 05/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18004 NW 6TH ST STE 104
PEMBROKE PINES FL
33029-2823
US

IV. Provider business mailing address

6730 NW 34TH AVE
FORT LAUDERDALE FL
33309-1227
US

V. Phone/Fax

Practice location:
  • Phone: 954-885-1024
  • Fax:
Mailing address:
  • Phone: 954-263-8954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberND902
License Number StateFL

VIII. Authorized Official

Name: ANNMARIE DUGGAN
Title or Position: MANAGER
Credential: MS,RD
Phone: 954-263-8954