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General NPI Number Information
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NPI Number | 1861216558
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Entity Type | Organization
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Legal Business Name | RENKU COLLECTIVE, INC
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Dates
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Enumeration Date | 11/11/2024
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 11950 RUDDY RUN
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City | ODESSA
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State | FL
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Zip | 33556-4096
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Country | US
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Telephone | 727-514-0451
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Fax |
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Provider Business Mailing Address
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Address Line | 13553 SR 54 # 133
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City | ODESSA
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State | FL
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Zip | 33556-3527
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Country | US
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Telephone | 727-514-0451
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JACKIE RATLIFF
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Credential |
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Telephone | 727-514-0451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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