Healthcare Provider Details

I. General information

NPI: 1083401897
Provider Name (Legal Business Name): URBAN ELITE REJUVENATION AND AESTHETICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 S CHURCH ST STE B
MURFREESBORO TN
37127-7149
US

IV. Provider business mailing address

2910 S CHURCH ST STE B
MURFREESBORO TN
37127-7149
US

V. Phone/Fax

Practice location:
  • Phone: 615-623-9600
  • Fax: 615-777-9366
Mailing address:
  • Phone: 615-623-9600
  • Fax: 615-777-9366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JACK D HYDRICK II
Title or Position: GENERAL PARTNER
Credential: NP
Phone: 615-623-9600