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General NPI Number Information
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NPI Number | 1477886810
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Entity Type | Organization
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Legal Business Name | NUTRITION COACHES, LLC
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Dates
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Enumeration Date | 09/17/2009
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Last Update Date | 02/06/2012
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Provider Practice Location Address
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Address Line | 1710 WELLS RD SUITE 728
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City | ORANGE PARK
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State | FL
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Zip | 32073-2332
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Country | US
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Telephone | 866-722-4955
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 426
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City | ORANGE PARK
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State | FL
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Zip | 32067-0426
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Country | US
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Telephone | 866-722-4955
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Fax |
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Authorized Official
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Title or Position | MANAGER/NUTRITION CONSULTANT
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Name | MRS. JUANA BURGOHY BROWN
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Credential | RD, LD/N, MPH
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Telephone | 866-722-4955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | ND3644
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License Number State | FL
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