=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902762859
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GLUCOTRITION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2026
-----------------------------------------------------
Last Update Date | 01/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4417 AGUALINDA BLVD
-----------------------------------------------------
City | CAPE CORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33914-6211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-469-0866
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1616 CAPE CORAL PKWY W STE 102
-----------------------------------------------------
City | CAPE CORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33914-8911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-469-0866
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | STEPHANIE FRY
-----------------------------------------------------
Credential | RN, RD, LDN
-----------------------------------------------------
Telephone | 239-469-0866
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133VN1006X
-----------------------------------------------------
Taxonomy Name | Metabolic Nutrition Registered Dietitian
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------