Healthcare Provider Details

I. General information

NPI: 1457010654
Provider Name (Legal Business Name): REJUVE HEALTH PLUS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3144 TAMPA RD STE 1
OLDSMAR FL
34677-2290
US

IV. Provider business mailing address

1838 WILMAR AVE
TARPON SPGS FL
34689-5751
US

V. Phone/Fax

Practice location:
  • Phone: 727-612-0705
  • Fax:
Mailing address:
  • Phone: 727-612-0705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code163WN1003X
TaxonomyNutrition Support Registered Nurse
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code163WS0121X
TaxonomyPlastic Surgery Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH JOANN VIANO
Title or Position: OWNER
Credential: RN
Phone: 727-612-0705