Organization Active NPI

Emily Rose Nutrition, LLC

Doing business as NuSparkle Nutrition

  • Registered Dietitian
  • Jacksonville, FL
National Provider Identifier
1174139679
Registry record updated Jun 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Legal business name
EMILY ROSE NUTRITION, LLC
Doing business as
NuSparkle Nutrition
Practice address
12866 Daybreak CT E
Jacksonville, FL 32246-7095
Phone
(904) 497-0401
Fax
(833) 773-1288
NPI assigned
Sep 20, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2026

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

Authorized official

Name
Mrs. Emily Rose Conyers, MS, RDN, CSR, LD/NNPI 1811474695
Title
Founder, Ceo, & Dietitian
Phone
(904) 497-0401

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
NutritionistGroup: 193200000X MULTI-SPECIALTY GROUP 133N00000X
Nutrition Education NutritionistGroup: 193200000X MULTI-SPECIALTY GROUP 133NN1002X
Registered DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133V00000X Primary
Renal Nutrition Registered DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133VN1005X
Metabolic Nutrition Registered DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133VN1006X
Gerontological Nutrition Registered DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133VN1101X
Obesity and Weight Management Nutrition Registered DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133VN1201X
Oncology Nutrition Registered DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133VN1301X
Sports Dietetics Nutrition Registered DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133VN1501X

Addresses

Primary practice location

12866 Daybreak CT E
Jacksonville, FL 32246-7095

Mailing address

12866 Daybreak CT E
Jacksonville, FL 32246-7095
Phone (904) 497-0401

Other names 1

  • NuSparkle Nutrition Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210115002125 FL Part B Supplier - Clinic/Group Practice 8820418890 Receives reassigned benefits from 1 practitioner
Practice locations: Jacksonville, FL

National Provider Directory

National Provider Directory

Locations

4320 Deerwood Lake Pkwy
Ste 101140
Jacksonville, FL 32216
Phone (904) 497-0401

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1600560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780704000000",
    "number": "1174139679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12866 DAYBREAK CT E",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322467095",
            "telephone_number": "904-497-0401",
            "fax_number": "833-773-1288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12866 DAYBREAK CT E",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322467095",
            "telephone_number": "904-497-0401",
            "fax_number": "833-773-1288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMILY ROSE NUTRITION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-20",
        "last_updated": "2026-06-06",
        "certification_date": "2026-06-06",
        "status": "A",
        "authorized_official_last_name": "CONYERS",
        "authorized_official_first_name": "EMILY",
        "authorized_official_middle_name": "ROSE",
        "authorized_official_title_or_position": "FOUNDER, CEO, & DIETITIAN",
        "authorized_official_telephone_number": "904-497-0401",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MS, RDN, CSR, LD/N"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nutritionist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133NN1002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nutritionist, Nutrition, Education",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "133VN1005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered, Nutrition, Renal",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133VN1006X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133VN1101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered, Nutrition, Gerontological",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133VN1201X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered, Nutrition, Obesity and Weight Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133VN1301X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered, Nutrition, Oncology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133VN1501X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered, Nutrition, Sports Dietetics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NuSparkle Nutrition",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.