Healthcare Provider Details

I. General information

NPI: 1265356497
Provider Name (Legal Business Name): SERENITY NUTRITION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 N PONCE DE LEON BLVD STE 3
ST AUGUSTINE FL
32084-2650
US

IV. Provider business mailing address

2200 N PONCE DE LEON BLVD STE 3
ST AUGUSTINE FL
32084-2650
US

V. Phone/Fax

Practice location:
  • Phone: 904-793-5765
  • Fax:
Mailing address:
  • Phone: 904-793-5765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: JULIE AVERY
Title or Position: CEO
Credential: RDN LDN CLC
Phone: 904-793-5765