Provider Demographics
NPI:1790404705
Name:HEALTHY HABITZ LLC
Entity Type:Organization
Organization Name:HEALTHY HABITZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, LDN
Authorized Official - Phone:407-353-4650
Mailing Address - Street 1:123 CRESTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-2632
Mailing Address - Country:US
Mailing Address - Phone:407-353-4650
Mailing Address - Fax:
Practice Address - Street 1:123 CRESTWOOD LN
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2632
Practice Address - Country:US
Practice Address - Phone:407-353-4650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-23
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty