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General NPI Number Information
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NPI Number | 1407792054
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Entity Type | Organization
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Legal Business Name | REVIVE INFUSION & WELLNESS, LLC
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Dates
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Enumeration Date | 04/27/2026
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Last Update Date | 04/29/2026
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Provider Practice Location Address
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Address Line | 14330 S PADRE ISLAND DR STE 114
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City | CORPUS CHRISTI
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State | TX
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Zip | 78418-6090
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Country | US
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Telephone | 833-248-3747
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Fax | 361-236-2415
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Provider Business Mailing Address
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Address Line | 14330 S PADRE ISLAND DR STE 114
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City | CORPUS CHRISTI
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State | TX
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Zip | 78418-6090
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Country | US
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Telephone | 833-248-3747
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Fax | 361-236-2415
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Authorized Official
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Title or Position | CEO
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Name | ANDREA HOLLEY
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Credential | NP
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Telephone | 409-682-5403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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