# TRACEY L O'NEILL LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Longevity Functional Wellness
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629725312
- **Authorized official:** TRACEY O'NEILL LDN, CNS (LICENSED DIETITIAN NUTRITIONIST)
- **Authorized official phone:** (904) 535-6901

## Contact information

- **Practice address:** 500 CANAL RD, PONTE VEDRA BEACH, FL 32082-4300
- **Practice address phone:** (904) 535-6901
- **Mailing address:** 500 CANAL RD, PONTE VEDRA BEACH, FL 32082-4300
- **Mailing address phone:** (904) 535-6901

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 133V00000X | Registered Dietitian | — | NULL | Yes |
| 133V00000X | Registered Dietitian | — | — | Yes |

## Other

- **Enumeration date:** 03/03/2022
- **Last updated:** 04/05/2023