| Revivecare Medical & Wellness Llc | |
|
2925 E South St Orlando FL 32803-6459 | |
| (321) 209-2203 | |
| (888) 344-9692 |
| Full Name | Revivecare Medical & Wellness Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2925 E South St, Orlando, Florida |
| Authorized Official Name and Position | Tima Doron (ARNP) |
| Authorized Official Contact | 4073008768 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revivecare Medical & Wellness Llc 1534 Birchwood Ave Kissimmee FL 34744-4015 Ph: (407) 300-8768 | Revivecare Medical & Wellness Llc 2925 E South St Orlando FL 32803-6459 Ph: (321) 209-2203 |
| NPI Number | 1659147486 |
|---|---|
| Provider Enumeration Date | 12/04/2023 |
| Last Update Date | 12/04/2023 |
| Medicare PECOS PAC ID | 8729438320 |
|---|---|
| Medicare Enrollment ID | O20231222000302 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659147486 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Tima Doron |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881055473 PECOS PAC ID: 0840557377 Enrollment ID: I20171207003223 |
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