MEDICARE: NOURISH HEALTHCARE 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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1730860453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOURISH HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	9755 CRESCENT VIEW DR S
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-5922
Country	:	US
Telephone Number	:	561-907-8620
Fax Number	:

Provider Business Practice Location Address
First Line	:	9755 CRESCENT VIEW DR S
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-5922
Country	:	US
Telephone Number	:	561-862-3944
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRACTIONER
Name	:	DR. ZAMAR TARA MCPHERSON
Credential	:	ND, RDN
Telephone Number	:	561-907-8620

Provider Enumeration Date	:	07/26/2023
Last Update Date	:	07/26/2023

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