Healthcare Provider Details

I. General information

NPI: 1780295618
Provider Name (Legal Business Name): UNUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MOONLIGHT CT
SAINT CLOUD FL
34771-9062
US

IV. Provider business mailing address

500 MOONLIGHT CT
SAINT CLOUD FL
34771-9062
US

V. Phone/Fax

Practice location:
  • Phone: 813-313-7779
  • Fax: 888-974-1047
Mailing address:
  • Phone: 813-313-7779
  • Fax: 888-974-1047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: REBECCA FITE BROOKS
Title or Position: MANAGER
Credential: RD
Phone: 813-313-7779