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Contact Information

OMNI NUTRITION LLC
404 UNITED DRIVE
NEW SMYRNA BEACH, FL32168
 Phone: 386-968-2170
 Fax: 386-310-0587
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dietitian, Registered

133V00000X 71 Registered Dietitian or Nutrition Professional
Indicates primary specialty

NPI Profile & details for OMNI NUTRITION LLC

NPI # 1104363605
LBN Legal business name OMNI NUTRITION LLC
Authorized official LARA CLEVENGER - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 01/23/2017
Last updated 08/11/2025 - About 10 months ago
Identifiers
FL License # ND6015
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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