Healthcare Provider Details

I. General information

NPI: 1780465559
Provider Name (Legal Business Name): ADVANCED REGENERATIVE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 N FEDERAL HWY STE 100
FORT LAUDERDALE FL
33308-3842
US

IV. Provider business mailing address

1870 N CORPORATE LAKES BLVD UNIT 267021
WESTON FL
33326-8837
US

V. Phone/Fax

Practice location:
  • Phone: 754-268-3108
  • Fax:
Mailing address:
  • Phone: 754-268-3108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. JORDAN AUGUSTIN
Title or Position: OWNER, CEO
Credential: APRN, PMHNP-BC
Phone: 954-461-3172