Florida Weight Loss LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Legal business name

FLORIDA WEIGHT LOSS LLC

Practice address

1590 79TH Ave N
Saint Petersburg, FL 33702-4039

Phone

(941) 705-2210

NPI assigned

Aug 12, 2020

Organization subpart

No

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

Authorized official

Name

Nicole M Fresta, RD

Title

Registered Dietitian

Phone

(941) 705-2210

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1597190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597190400000",
    "number": "1801407804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1590 79TH AVE N",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337024039",
            "telephone_number": "941-705-2210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1590 79TH AVE N",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337024039",
            "telephone_number": "941-705-2210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA WEIGHT LOSS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-12",
        "last_updated": "2020-08-12",
        "certification_date": "2020-08-12",
        "status": "A",
        "authorized_official_last_name": "FRESTA",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "REGISTERED DIETITIAN",
        "authorized_official_telephone_number": "941-705-2210",
        "authorized_official_credential": "RD"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1487264339",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Registered Dietitian in Saint Petersburg, FL
• Providers in Saint Petersburg, FL by specialty
• Registered Dietitian in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2020; 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.