Organization
TRACEY L O'NEILL LLC
Active
Other names
Longevity Functional Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
TRACEY O'NEILL LDN, CNS (LICENSED DIETITIAN NUTRITIONIST)
(904) 535-6901
Entity
Organization
Contact information
Practice address
500 CANAL RD, PONTE VEDRA BEACH, FL 32082-4300
(904) 535-6901
Mailing address
500 CANAL RD, PONTE VEDRA BEACH, FL 32082-4300
(904) 535-6901
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
03/03/2022
Last updated
04/05/2023
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