Provider Demographics
NPI:1265952568
Name:COMPASS NUTRITION LLC
Entity type:Organization
Organization Name:COMPASS NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLDUC
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN, MFCS
Authorized Official - Phone:386-212-7314
Mailing Address - Street 1:840 ANGELINA CT
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-5378
Mailing Address - Country:US
Mailing Address - Phone:386-212-7314
Mailing Address - Fax:
Practice Address - Street 1:840 ANGELINA COURT
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127
Practice Address - Country:US
Practice Address - Phone:386-212-7314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND6478133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty