=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396596466
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REGENERATIVE WELLNESS SOLUTIONS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2024
-----------------------------------------------------
Last Update Date | 03/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1617 PARK PLACE AVE STE 110
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76110-1300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-717-7294
-----------------------------------------------------
Fax | 817-717-9388
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6080 S HULEN ST STE 360
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76132-4810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-903-8383
-----------------------------------------------------
Fax | 817-717-9388
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER
-----------------------------------------------------
Name | INGRID HINOJOSA
-----------------------------------------------------
Credential | APRN, FNP-C
-----------------------------------------------------
Telephone | 817-903-8383
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------