MEDICARE: NUTRAEVOLUTION DIETETICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1033977418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUTRAEVOLUTION DIETETICS

Provider Business Mailing Address
First Line	:	2872 ALASKAN WAY
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32226-5847
Country	:	US
Telephone Number	:	815-993-1080
Fax Number	:

Provider Business Practice Location Address
First Line	:	2872 ALASKAN WAY
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32226-5847
Country	:	US
Telephone Number	:	815-993-1080
Fax Number	:

Authorized Official
Title or Position	:	CEO/DIETITIAN
Name	:	JENNIFER ALVEY-DZIERZYNSKI
Credential	:	RD, LDN
Telephone Number	:	815-993-1080

Provider Enumeration Date	:	03/11/2024
Last Update Date	:	03/11/2024

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Directions to “NUTRAEVOLUTION DIETETICS ” Practice Location

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