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General NPI Number Information
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NPI Number | 1922842517
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Entity Type | Organization
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Legal Business Name | NICOLE SCONZO ENTERPRISES LLC
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Dates
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Enumeration Date | 06/19/2024
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Last Update Date | 06/19/2024
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Provider Practice Location Address
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Address Line | 601 SE KARRIGAN TER
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34983-3237
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Country | US
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Telephone | 561-409-3117
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Fax |
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Provider Business Mailing Address
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Address Line | 9858 CLINT MOORE RD # C133
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City | BOCA RATON
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State | FL
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Zip | 33496-1034
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Country | US
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Telephone | 561-409-3117
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NICOLE SCONZO
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Credential |
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Telephone | 561-409-3117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1006X
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Taxonomy Name | Metabolic Nutrition 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 | 133VN1201X
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Taxonomy Name | Obesity and Weight Management Nutrition Registered Dietitian
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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 | 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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