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General NPI Number Information
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NPI Number | 1659147486
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Entity Type | Organization
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Legal Business Name | REVIVECARE MEDICAL & WELLNESS LLC
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Dates
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Enumeration Date | 12/04/2023
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 2925 E SOUTH ST
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City | ORLANDO
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State | FL
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Zip | 32803-6459
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Country | US
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Telephone | 321-209-2203
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Fax | 888-344-9692
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Provider Business Mailing Address
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Address Line | 1534 BIRCHWOOD AVE
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City | KISSIMMEE
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State | FL
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Zip | 34744-4015
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Country | US
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Telephone | 407-300-8768
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Fax |
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Authorized Official
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Title or Position | ARNP
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Name | TIMA DORON
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Credential | ARNP
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Telephone | 407-300-8768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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