Healthcare Provider Details

I. General information

NPI: 1922842517
Provider Name (Legal Business Name): NICOLE SCONZO ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 SE KARRIGAN TER
PORT SAINT LUCIE FL
34983-3237
US

IV. Provider business mailing address

9858 CLINT MOORE RD # C133
BOCA RATON FL
33496-1034
US

V. Phone/Fax

Practice location:
  • Phone: 561-409-3117
  • Fax:
Mailing address:
  • Phone: 561-409-3117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: NICOLE SCONZO
Title or Position: OWNER
Credential:
Phone: 561-409-3117