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General NPI Number Information
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NPI Number | 1487326476
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Entity Type | Organization
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Legal Business Name | RENUVA WELLNESS LLC
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Dates
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Enumeration Date | 09/29/2021
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Last Update Date | 09/29/2021
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Provider Practice Location Address
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Address Line | 8910 MIRAMAR PKWY STE 200
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City | MIRAMAR
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State | FL
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Zip | 33025-4963
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Country | US
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Telephone | 305-709-8343
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Fax |
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Provider Business Mailing Address
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Address Line | 8910 MIRAMAR PKWY STE 200
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City | MIRAMAR
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State | FL
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Zip | 33025-4963
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | MS. ELSA ASHLEY FREDERIC
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Credential | FNP-BC
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Telephone | 786-718-3813
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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