Provider Demographics
NPI:1477886810
Name:NUTRITION COACHES, LLC
Entity Type:Organization
Organization Name:NUTRITION COACHES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/NUTRITION CONSULTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUANA
Authorized Official - Middle Name:BURGOHY
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD/N, MPH
Authorized Official - Phone:866-722-4955
Mailing Address - Street 1:PO BOX 426
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32067-0426
Mailing Address - Country:US
Mailing Address - Phone:866-722-4955
Mailing Address - Fax:
Practice Address - Street 1:1710 WELLS RD
Practice Address - Street 2:SUITE 728
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-2332
Practice Address - Country:US
Practice Address - Phone:866-722-4955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-17
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND3644261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center