Provider Demographics
NPI:1619408861
Name:EXPERT NUTRITION & FITNESS LLC
Entity Type:Organization
Organization Name:EXPERT NUTRITION & FITNESS LLC
Other - Org Name:JULIA L CAIRNS-MIGONE SOLE MBR
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:M
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-879-8700
Mailing Address - Street 1:3896 SW HALE ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-4041
Mailing Address - Country:US
Mailing Address - Phone:772-418-3298
Mailing Address - Fax:
Practice Address - Street 1:10050 SW INNOVATION WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2117
Practice Address - Country:US
Practice Address - Phone:772-879-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND7611133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLND7611OtherLICENSE NUMBER