Healthcare Provider Details

I. General information

NPI: 1649067638
Provider Name (Legal Business Name): LET'S REJUVENATE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5218 JAMMES RD # B10
JACKSONVILLE FL
32210-7700
US

IV. Provider business mailing address

14060 RED ROCK LAKE DR
JACKSONVILLE FL
32226-5014
US

V. Phone/Fax

Practice location:
  • Phone: 904-566-7985
  • Fax:
Mailing address:
  • Phone: 904-566-7985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: CIERRA MUHAMMAD
Title or Position: NURSE
Credential: NP
Phone: 904-566-7985