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General NPI Number Information
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NPI Number | 1790404705
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Entity Type | Organization
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Legal Business Name | HEALTHY HABITZ LLC
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Dates
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Enumeration Date | 08/23/2022
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Last Update Date | 08/24/2022
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Provider Practice Location Address
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Address Line | 123 CRESTWOOD LN
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City | LARGO
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State | FL
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Zip | 33770-2632
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Country | US
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Telephone | 407-353-4650
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Fax |
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Provider Business Mailing Address
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Address Line | 123 CRESTWOOD LN
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City | LARGO
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State | FL
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Zip | 33770-2632
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Country | US
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Telephone | 407-353-4650
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | JESSICA TAS
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Credential | RN, LDN
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Telephone | 407-353-4650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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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 | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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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 | 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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