OMNI NUTRITION LLC – Registered Dietitian, NPI 1104363605

OMNI NUTRITION LLC is a healthcare provider. based in Edgewater, Florida. specializing in Registered Dietitian. The organization holds a License No. ND6015 (FL). The NPI Number for OMNI NUTRITION LLC is 1104363605

Main info

Organization
Name
OMNI NUTRITION LLC
NPI
1104363605
Phone
Not provided
Address
3588 OMNI CIR
Authorized Official
LARA L CLEVENGER OWNER RD
Enumeration Date
23 January 2017
Last Update Date
11 August 2025
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience32
Completeness85
Years active:9State licenses:1Digital endpointsOther names

Provider Addresses for OMNI NUTRITION LLC

  • 3588 OMNI CIR

    EDGEWATER, FL 32141

    Phone:

    Type: Mailing

  • 3126 TAMARIND DRIVE

    EDGEWATER, FL 321416008

    Phone: (386) 968-2170

    Fax: (386) 310-0587

    Type: Mailing

  • 404 UNITED DRIVE

    NEW SMYRNA BEACH, FL 32168

    Phone: (386) 968-2170

    Fax: (386) 310-0587

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

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Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 32141)

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Reviews

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Frequently asked questions

What is the 10-digit NPI for OMNI NUTRITION LLC?
OMNI NUTRITION LLC — NPI 1104363605 — is the standard way to identify this listing.
Is OMNI NUTRITION LLC still practicing?
OMNI NUTRITION LLC is currently listed as active in the public NPI registry.
What is OMNI NUTRITION LLC best known for clinically?
Directory data describes OMNI NUTRITION LLC with Registered Dietitian. Clinical services aligned with this taxonomy classification.
Where is OMNI NUTRITION LLC based?
OMNI NUTRITION LLC is tied to Edgewater, Florida in the data we show; additional addresses may exist on the full record.
How many locations tie to this NPI?
4 practice locations appear in the available data.

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