Provider Demographics
NPI:1962286039
Name:JENNIFER MANN NUTRITION, LLC
Entity type:Organization
Organization Name:JENNIFER MANN NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:954-592-0337
Mailing Address - Street 1:9553 FOX TROT LN
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-4107
Mailing Address - Country:US
Mailing Address - Phone:954-592-0337
Mailing Address - Fax:
Practice Address - Street 1:2630 W BROWARD BLVD STE 203
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-1315
Practice Address - Country:US
Practice Address - Phone:954-787-2554
Practice Address - Fax:954-678-2590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-21
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, RenalGroup - Single Specialty