Provider Demographics
NPI:1760069629
Name:NUTRITION OF EVE LLC
Entity Type:Organization
Organization Name:NUTRITION OF EVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED HOLISTIC NUTRITIONIST CEO
Authorized Official - Prefix:
Authorized Official - First Name:LACIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRISBON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-455-8258
Mailing Address - Street 1:13166 ODYSSEY LAKE WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-4642
Mailing Address - Country:US
Mailing Address - Phone:407-455-8258
Mailing Address - Fax:
Practice Address - Street 1:13166 ODYSSEY LAKE WAY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-4642
Practice Address - Country:US
Practice Address - Phone:407-455-8258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1982292173OtherNUTRITION AND WELLNESS