Healthcare Provider Details

I. General information

NPI: 1144041740
Provider Name (Legal Business Name): RESTORATIVE HEALTHCARE SOLUTIONS OF NORTH FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3847 FEATHERSTONE CT
MIDDLEBURG FL
32068-4169
US

IV. Provider business mailing address

3847 FEATHERSTONE CT
MIDDLEBURG FL
32068-4169
US

V. Phone/Fax

Practice location:
  • Phone: 904-599-9085
  • Fax:
Mailing address:
  • Phone: 904-599-9085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIE RABENOLD
Title or Position: OWNER/NURSE PRACTITONER
Credential: NP
Phone: 904-599-9085