Lifestyle Wellness, LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

ND5247 Issued in FL

Legal business name

LIFESTYLE WELLNESS, LLC

Practice address

519 NW 60TH Street
Suite E
Gainesville, FL 32607

Phone

(352) 375-1158

NPI assigned

Feb 8, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Laura Jane Acosta, MS, RD, LD/N

Title

Owner

Phone

(352) 375-1158

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1265587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265587200000",
    "number": "1093047623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3606 NW 24TH BLVD",
            "address_2": "#306",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "32605",
            "telephone_number": "352-375-1158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "519 NW 60TH STREET",
            "address_2": "SUITE E",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "32607",
            "telephone_number": "352-375-1158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESTYLE WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-08",
        "last_updated": "2010-02-08",
        "status": "A",
        "authorized_official_last_name": "ACOSTA",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "JANE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "352-375-1158",
        "authorized_official_credential": "MS, RD, LD/N"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": "FL",
            "license": "ND5247",
            "primary": true
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": "FL",
            "license": "MA53113",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Registered Dietitian in Gainesville, FL
• Providers in Gainesville, FL by specialty
• Registered Dietitian in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.