Jamie Basak, RD/LDN | |
24829 Vintage Ct, Lutz, FL 33559-7401 | |
(727) 342-3915 | |
Not Available |
Full Name | Jamie Basak |
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Gender | Female |
Speciality | Dietitian, Registered |
Location | 24829 Vintage Ct, Lutz, Florida |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1619490430 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
133V00000X | Dietitian, Registered | ND7286 (Florida) | Primary |
Provider Name | Ilivewell Nutrition Therapy, Llc |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1093150070 PECOS PAC ID: 5496186009 Enrollment ID: O20200515000498 |
Mailing Address | Practice Location Address |
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Jamie Basak, RD/LDN 24829 Vintage Ct, Lutz, FL 33559-7401 Ph: (727) 342-3915 | Jamie Basak, RD/LDN 24829 Vintage Ct, Lutz, FL 33559-7401 Ph: (727) 342-3915 |
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