| Resilient Nutrition | |
|
407 Coconut Ave E Port Saint Lucie FL 34952-1328 | |
| (802) 376-8964 | |
| Not Available |
| Full Name | Resilient Nutrition |
|---|---|
| Speciality | Dietitian, Registered |
| Location | 407 Coconut Ave E, Port Saint Lucie, Florida |
| Authorized Official Name and Position | Tegan Bissell (FOUNDER) |
| Authorized Official Contact | 8023768964 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Resilient Nutrition 407 Coconut Ave E Port Saint Lucie FL 34952-1328 Ph: (802) 376-8964 | Resilient Nutrition 407 Coconut Ave E Port Saint Lucie FL 34952-1328 Ph: (802) 376-8964 |
| NPI Number | 1720855513 |
|---|---|
| Provider Enumeration Date | 12/11/2023 |
| Last Update Date | 01/04/2024 |
| Medicare PECOS PAC ID | 8123465515 |
|---|---|
| Medicare Enrollment ID | O20240320004218 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720855513 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 133V00000X | Dietitian, Registered | (* (Not Available)) | Primary |
| Provider Name | Tegan Bissell |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1437542230 PECOS PAC ID: 4082932371 Enrollment ID: I20150416002416 |
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