Provider Demographics
NPI:1720855513
Name:RESILIENT NUTRITION
Entity Type:Organization
Organization Name:RESILIENT NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:TEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BISSELL
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN, CDCES
Authorized Official - Phone:802-376-8964
Mailing Address - Street 1:407 COCONUT AVE E
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-1328
Mailing Address - Country:US
Mailing Address - Phone:802-376-8964
Mailing Address - Fax:
Practice Address - Street 1:407 COCONUT AVE E
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-1328
Practice Address - Country:US
Practice Address - Phone:802-376-8964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty