Provider Demographics
NPI:1538520291
Name:NAPLES NUTRITION ASSOCIATES LLC
Entity type:Organization
Organization Name:NAPLES NUTRITION ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:ISABELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FAUCHER
Authorized Official - Suffix:
Authorized Official - Credentials:RD LD
Authorized Official - Phone:954-464-5839
Mailing Address - Street 1:4522 EXECUTIVE DR STE 103
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-9013
Mailing Address - Country:US
Mailing Address - Phone:239-231-1158
Mailing Address - Fax:239-254-0341
Practice Address - Street 1:4522 EXECUTIVE DR STE 103
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-9013
Practice Address - Country:US
Practice Address - Phone:239-231-1158
Practice Address - Fax:239-254-0341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND2784133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty