NPIMap

Organization Active NPI

Nutrition Clinic LLC

Doing business as The Nutrition Clinic

  • Registered Dietitian
  • Port St Lucie, FL
National Provider Identifier
1760038939
Registry record updated Dec 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Legal business name
NUTRITION CLINIC LLC
Doing business as
The Nutrition Clinic
Practice address
10570 S US Highway 1 Ste 300
Port St Lucie, FL 34952-5606
Phone
(772) 878-8227
Fax
(772) 324-7863
NPI assigned
Aug 14, 2019
Last updated
Dec 28, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2021

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

Authorized official

Name
Phara Jourdan Taylor, RDNPI 1740342799
Title
Ceo
Phone
(772) 800-3014

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X Primary

Addresses

Primary practice location

10570 S US Highway 1 Ste 300
Port St Lucie, FL 34952-5606

Mailing address

402 NW Lyndhurst CT FL 34983
Port Saint Lucie, FL 34983-3440
Phone (772) 878-8227

Other identifiers 1

IdentifierTypeStateIssuer
005491300MedicaidFL

Other names 1

  • The Nutrition Clinic Doing business as

National Provider Directory

National Provider Directory

Locations

10570 S US Highway 1
Port St Lucie, FL 34952
Phone (772) 214-1195

6839 S US Highway 1
Port St Lucie, FL 34952
Phone (772) 237-0229

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1565740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640649600000",
    "number": "1760038939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 NW LYNDHURST CT FL 34983",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349833440",
            "telephone_number": "772-878-8227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10570 S US HIGHWAY 1 STE 300",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349525606",
            "telephone_number": "772-878-8227",
            "fax_number": "772-324-7863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NUTRITION CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-14",
        "last_updated": "2021-12-28",
        "certification_date": "2021-08-22",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "PHARA",
        "authorized_official_middle_name": "JOURDAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "772-800-3014",
        "authorized_official_credential": "RD"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005491300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Nutrition Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Nutrition Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port St Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2021; 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.