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Organization
NUTRITION CLINIC LLC
Active
Organization
NUTRITION CLINIC LLC
Active
Other names
The Nutrition Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
PHARA JOURDAN TAYLOR RD (CEO)
(772) 800-3014
Entity
Organization
Contact information
Practice address
10570 S US HIGHWAY 1 STE 300, PORT ST LUCIE, FL 34952-5606
(772) 878-8227
(772) 324-7863
Mailing address
402 NW LYNDHURST CT FL 34983, PORT SAINT LUCIE, FL 34983-3440
(772) 878-8227
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005491300
—
FL
Enumeration date
08/14/2019
Last updated
12/28/2021
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