Provider Demographics
NPI:1669843819
Name:NUTRITION COACH- RD, LLC
Entity Type:Organization
Organization Name:NUTRITION COACH- RD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:C
Authorized Official - Last Name:ZINK
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN
Authorized Official - Phone:772-215-1222
Mailing Address - Street 1:3010 SW SOLITAIRE PALM DR
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-6302
Mailing Address - Country:US
Mailing Address - Phone:772-215-1222
Mailing Address - Fax:
Practice Address - Street 1:1807 S KANNER HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-7204
Practice Address - Country:US
Practice Address - Phone:772-215-1222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 7333133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty