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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