Provider Demographics
NPI:1124598271
Name:DR. AZIZ NUTRITION & WELLNESS
Entity Type:Organization
Organization Name:DR. AZIZ NUTRITION & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:AZIZ
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LDN, CHES, CHC
Authorized Official - Phone:850-329-0035
Mailing Address - Street 1:1512 JOHN SIMS PKWY E STE 355
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-2143
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1512 JOHN SIMS PKWY E STE 355
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-2143
Practice Address - Country:US
Practice Address - Phone:850-329-0035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMERALD COAST FOOD SAFETY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-03
Last Update Date:2019-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty