Healthcare Provider Details

I. General information

NPI: 1811789746
Provider Name (Legal Business Name): MOBILE INFUSION RN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 05/19/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 AVE BSW 200-31
WINTER HAVEN FL
33880
US

IV. Provider business mailing address

332 AVE BSW 200-31
WINTER HAVEN FL
33880
US

V. Phone/Fax

Practice location:
  • Phone: 407-837-2613
  • Fax: 407-887-9521
Mailing address:
  • Phone: 407-837-2613
  • Fax: 407-887-9521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH R RENFORT JR.
Title or Position: OWNER, CEO
Credential: RN
Phone: 407-837-2613