Provider Demographics
NPI:1730436064
Name:PEACE OF NUTRITION, LLC
Entity type:Organization
Organization Name:PEACE OF NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LEAD DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRIN
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD/N
Authorized Official - Phone:904-377-6190
Mailing Address - Street 1:301 ELEUTHERA CT
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-9617
Mailing Address - Country:US
Mailing Address - Phone:904-377-6190
Mailing Address - Fax:904-808-4702
Practice Address - Street 1:7 WALDO ST
Practice Address - Street 2:SUITE 205
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-2718
Practice Address - Country:US
Practice Address - Phone:904-377-6190
Practice Address - Fax:904-808-4702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 5445261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service