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General NPI Number Information
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NPI Number | 1265356497
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Entity Type | Organization
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Legal Business Name | SERENITY NUTRITION INC
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Dates
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Enumeration Date | 08/10/2026
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Last Update Date | 08/10/2026
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Provider Practice Location Address
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Address Line | 2200 N PONCE DE LEON BLVD STE 3
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City | ST AUGUSTINE
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State | FL
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Zip | 32084-2650
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Country | US
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Telephone | 904-793-5765
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 N PONCE DE LEON BLVD STE 3
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City | ST AUGUSTINE
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State | FL
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Zip | 32084-2650
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Country | US
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Telephone | 904-793-5765
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JULIE AVERY
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Credential | RDN LDN CLC
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Telephone | 904-793-5765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State |
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