Provider Demographics
NPI:1912214362
Name:LIVING FRESH LLC
Entity Type:Organization
Organization Name:LIVING FRESH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NUTRITIONIST/ DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD/N
Authorized Official - Phone:954-205-2334
Mailing Address - Street 1:1840 NE 34TH CT
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1022
Mailing Address - Country:US
Mailing Address - Phone:954-205-2334
Mailing Address - Fax:
Practice Address - Street 1:1840 NE 34TH CT
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33306-1022
Practice Address - Country:US
Practice Address - Phone:954-205-2334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-07
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4739133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty