MEDICARE: NUTRITION BY JORDANA 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	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1508431917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUTRITION BY JORDANA LLC

Provider Business Mailing Address
First Line	:	10710 CORAL ST
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33076-2210
Country	:	US
Telephone Number	:	561-716-4495
Fax Number	:

Provider Business Practice Location Address
First Line	:	5531 N UNIVERSITY DR STE 101
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-4649
Country	:	US
Telephone Number	:	561-716-4495
Fax Number	:

Authorized Official
Title or Position	:	MGR
Name	:	JORDANA RAE TOBELEM
Credential	:	RD
Telephone Number	:	561-716-4495

Provider Enumeration Date	:	05/26/2021
Last Update Date	:	05/26/2021

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Directions to “NUTRITION BY JORDANA LLC ” Practice Location

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