Provider Demographics
NPI:1134763055
Name:VILLAGE NUTRITIONIST
Entity type:Organization
Organization Name:VILLAGE NUTRITIONIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:LOGOMARSINO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, RD, LD/N
Authorized Official - Phone:352-430-5487
Mailing Address - Street 1:842 MAYBANK LOOP
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162
Mailing Address - Country:US
Mailing Address - Phone:352-430-5487
Mailing Address - Fax:
Practice Address - Street 1:842 MAYBANK LOOP
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162
Practice Address - Country:US
Practice Address - Phone:352-430-5487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date: