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General NPI Number Information
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NPI Number | 1952294175
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Entity Type | Organization
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Legal Business Name | RENEW PSYCHIATRY
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Dates
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Enumeration Date | 05/29/2025
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 108 N PINE AVE
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City | OCALA
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State | FL
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Zip | 34475-6619
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Country | US
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Telephone | 352-877-9907
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Fax |
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Provider Business Mailing Address
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Address Line | 6160 SW HIGHWAY 200 STE 110
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City | OCALA
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State | FL
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Zip | 34476-5519
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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 | APRN
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Name | NICOLE HENNESSY
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Credential |
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Telephone | 352-351-8077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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