Organization
PUREVITAL NUTRITION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MERCEDES WAUGAMAN (OWNER)
(904) 763-9722
Entity
Organization
Contact information
Practice address
10752 DEERWOOD PARK BLVD STE 100, JACKSONVILLE, FL 32256-4846
(904) 763-9722
(904) 833-3377
Mailing address
5274 LEGACY PINES WAY, JACKSONVILLE, FL 32224-4410
(904) 763-9722
(904) 833-3377
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
12/15/2025
Last updated
12/15/2025
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