Provider Demographics
NPI:1003305053
Name:SOUTH FLORIDA NUTRITION CONSULTANTS LLC
Entity Type:Organization
Organization Name:SOUTH FLORIDA NUTRITION CONSULTANTS LLC
Other - Org Name:ANNMARIE DUGGAN
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUGGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS,RD
Authorized Official - Phone:954-263-8954
Mailing Address - Street 1:6730 NW 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1227
Mailing Address - Country:US
Mailing Address - Phone:954-263-8954
Mailing Address - Fax:
Practice Address - Street 1:18004 NW 6TH ST STE 104
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2823
Practice Address - Country:US
Practice Address - Phone:954-885-1024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-05
Last Update Date:2018-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND902133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, RenalGroup - Single Specialty