Provider Demographics
NPI:1922153592
Name:BAY AREA NUTRITION INC
Entity Type:Organization
Organization Name:BAY AREA NUTRITION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRUBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-977-5557
Mailing Address - Street 1:5041 WESLEY DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1376
Mailing Address - Country:US
Mailing Address - Phone:813-363-3555
Mailing Address - Fax:813-972-9211
Practice Address - Street 1:3000 E FLETCHER AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4656
Practice Address - Country:US
Practice Address - Phone:813-977-5557
Practice Address - Fax:813-972-9211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND3503133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU5122AMedicare ID - Type Unspecified