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General NPI Number Information
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NPI Number | 1730436064
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Entity Type | Organization
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Legal Business Name | PEACE OF NUTRITION, LLC
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Dates
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Enumeration Date | 08/06/2012
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Last Update Date | 08/06/2012
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Provider Practice Location Address
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Address Line | 7 WALDO ST SUITE 205
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City | ST AUGUSTINE
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State | FL
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Zip | 32084-2718
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Country | US
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Telephone | 904-377-6190
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Fax | 904-808-4702
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Provider Business Mailing Address
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Address Line | 301 ELEUTHERA CT
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City | ST AUGUSTINE
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State | FL
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Zip | 32095-9617
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Country | US
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Telephone | 904-377-6190
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Fax | 904-808-4702
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Authorized Official
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Title or Position | OWNER/LEAD DIETITIAN
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Name | AMANDA PERRIN
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Credential | RD, LD/N
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Telephone | 904-377-6190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | ND 5445
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License Number State | FL
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