Organization
LIFESTYLE WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA JANE ACOSTA MS, RD, LD/N (OWNER)
(352) 375-1158
Entity
Organization
Contact information
Practice address
519 NW 60TH STREET, SUITE E, GAINESVILLE, FL 32607
(352) 375-1158
Mailing address
3606 NW 24TH BLVD, #306, GAINESVILLE, FL 32605
(352) 375-1158
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
ND5247
FL
225700000X
Massage Therapist
MA53113
FL
Other
Enumeration date
02/08/2010
Last updated
02/08/2010
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