Provider Demographics
NPI:1073766796
Name:NUTRIGENOMICS OF FLORIDA, INC.
Entity Type:Organization
Organization Name:NUTRIGENOMICS OF FLORIDA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAZUKO
Authorized Official - Middle Name:
Authorized Official - Last Name:CURTIN
Authorized Official - Suffix:
Authorized Official - Credentials:COLLEGE DEGREE
Authorized Official - Phone:813-979-6200
Mailing Address - Street 1:12690 TELECOM DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33637-0935
Mailing Address - Country:US
Mailing Address - Phone:813-979-6200
Mailing Address - Fax:
Practice Address - Street 1:12690 TELECOM DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33637-0935
Practice Address - Country:US
Practice Address - Phone:813-979-6200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory