MEDICARE: FOOD FOR THOUGHT - A WELLNESS COMPANY, LLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1396527917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOD FOR THOUGHT - A WELLNESS COMPANY, LLC

Provider Business Mailing Address
First Line	:	12161 MERCADO DR
Second Line	:	PMB 409
City	:	VENICE
State	:	FL
Zip	:	34293-4399
Country	:	US
Telephone Number	:	941-347-0623
Fax Number	:

Provider Business Practice Location Address
First Line	:	13898 VANCANZA DR
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34293
Country	:	US
Telephone Number	:	941-347-0623
Fax Number	:	941-208-9398

Authorized Official
Title or Position	:	OWNER
Name	:	DR. AUDRA GLUNT
Credential	:	APRN, DNP
Telephone Number	:	941-347-0623

Provider Enumeration Date	:	10/18/2023
Last Update Date	:	12/04/2025

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