MEDICARE: JLM NUTRITION & WELLNESS, 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	ND6643	FL

General Provider Information

NPI Number	:	1780035766
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JLM NUTRITION & WELLNESS, LLC

Provider Business Mailing Address
First Line	:	963 NW SPRUCE RIDGE DR
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-9569
Country	:	US
Telephone Number	:	772-334-4687
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 SE OCEAN BLVD
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-2471
Country	:	US
Telephone Number	:	772-334-4687
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. JENNIFER MUZZIN
Credential	:	RDN, LDN
Telephone Number	:	772-334-3487

Provider Enumeration Date	:	06/30/2016
Last Update Date	:	06/30/2016

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