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General NPI Number Information
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NPI Number | 1780465559
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Entity Type | Organization
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Legal Business Name | ADVANCED REGENERATIVE HEALTH LLC
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Dates
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Enumeration Date | 10/09/2023
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Last Update Date | 10/09/2023
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Provider Practice Location Address
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Address Line | 5100 N FEDERAL HWY STE 100
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-3842
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Country | US
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Telephone | 754-268-3108
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Fax |
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Provider Business Mailing Address
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Address Line | 1870 N CORPORATE LAKES BLVD UNIT 267021
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City | WESTON
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State | FL
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Zip | 33326-8837
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Country | US
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Telephone | 754-268-3108
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Fax |
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Authorized Official
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Title or Position | OWNER, CEO
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Name | MR. JORDAN AUGUSTIN
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Credential | APRN, PMHNP-BC
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Telephone | 954-461-3172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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