Provider Demographics
NPI:1093394678
Name:NUTRINERD LLC
Entity Type:Organization
Organization Name:NUTRINERD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HAMLIN
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:352-651-2669
Mailing Address - Street 1:3840 S APOPKA AVE
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-7091
Mailing Address - Country:US
Mailing Address - Phone:352-651-2669
Mailing Address - Fax:352-726-2847
Practice Address - Street 1:3840 S APOPKA AVE
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-7091
Practice Address - Country:US
Practice Address - Phone:408-489-2251
Practice Address - Fax:352-726-2847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-02
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8946OtherLICENSE
FL8946OtherSTATE LICENSE