MEDICARE: RENOVO MENTAL HEALTH CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1982568309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENOVO MENTAL HEALTH CORP

Provider Business Mailing Address
First Line	:	1055 MOON LAKE DR
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34104-6619
Country	:	US
Telephone Number	:	786-300-2787
Fax Number	:

Provider Business Practice Location Address
First Line	:	1055 MOON LAKE DR
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34104-6619
Country	:	US
Telephone Number	:	786-300-2787
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ZORAYA ALVAREZ HERNANDEZ
Credential	:	APRN
Telephone Number	:	786-300-2787

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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