Active NPI
Michelle John, RD
- Nutritionist
- St Augustine, FL
National Provider Identifier
1114233764
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutritionist
- License
- 5738
- Practice address
- 400 Health Park Blvd
Nutrition Services
St Augustine, FL 32086-5784 - Phone
- (904) 819-4404
- Fax
- (904) 819-4936
- NPI assigned
- Aug 20, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutritionist | 133N00000X | 5738 | FL | Primary |
| Registered Dietitian | 133V00000X | 5738 | FL |
Addresses
Primary practice location
400 Health Park Blvd
Nutrition Services
St Augustine, FL 32086-5784
Mailing address
400 Health Park Blvd
Nutrition Services
St Augustine, FL 32086-5784
Phone (904) 819-4404
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5738 | FL | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1282262400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1282262400000",
"number": "1114233764",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 HEALTH PARK BLVD",
"address_2": "NUTRITION SERVICES",
"city": "ST AUGUSTINE",
"state": "FL",
"postal_code": "320865784",
"telephone_number": "904-819-4404",
"fax_number": "904-819-4936"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 HEALTH PARK BLVD",
"address_2": "NUTRITION SERVICES",
"city": "ST AUGUSTINE",
"state": "FL",
"postal_code": "320865784",
"telephone_number": "904-819-4404",
"fax_number": "904-819-4936"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHN",
"first_name": "MICHELLE",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-08-20",
"last_updated": "2010-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": "FL",
"license": "5738",
"primary": true
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "FL",
"license": "5738",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Augustine, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 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.