Healthcare Provider Details

I. General information

NPI: 1164391579
Provider Name (Legal Business Name): HAPPY TUMMY NUTRITION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N TAMPA ST STE 1550
TAMPA FL
33602-4737
US

IV. Provider business mailing address

PO BOX 130334
TAMPA FL
33681-0334
US

V. Phone/Fax

Practice location:
  • Phone: 813-590-7565
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN FUSTOS
Title or Position: REGISTERED DIETITIAN & OWNER
Credential: MS, RDN, CSP, LD, CL
Phone: 813-590-7565