Healthcare Provider Details

I. General information

NPI: 1861177503
Provider Name (Legal Business Name): ENERJIZE INFUSION AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8850 GOODBYS EXECUTIVE DR STE B
JACKSONVILLE FL
32217-4668
US

IV. Provider business mailing address

8850 GOODBYS EXECUTIVE DR STE B
JACKSONVILLE FL
32217-4668
US

V. Phone/Fax

Practice location:
  • Phone: 904-604-0127
  • Fax:
Mailing address:
  • Phone: 904-604-0127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RYAN PETERS
Title or Position: CEO
Credential:
Phone: 904-604-0127