Revamp Health Agency LLC

Primary specialty

Registered NurseTaxonomy code 163W00000X

Legal business name

REVAMP HEALTH AGENCY LLC

Practice address

5781 SW 137TH Ave
Miami, FL 33183-1103

Phone

(305) 603-9196

NPI assigned

May 23, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Jeannette Pena, RNNPI 1497528392

Title

Owner

Phone

(786) 501-0206

Specialties & licenses 1

Addresses

Other names 1

• Revamp Health Medspa Other name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jeannette Pena

  • Acute Care Nurse Practitioner
  • Miami, FL
  • NPI 1497528392
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1653264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653264000000",
    "number": "1104564962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10144 SW 141ST CT",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331866807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5781 SW 137TH AVE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331831103",
            "telephone_number": "305-603-9196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVAMP HEALTH AGENCY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-23",
        "last_updated": "2022-05-23",
        "certification_date": "2022-05-23",
        "status": "A",
        "authorized_official_last_name": "PENA",
        "authorized_official_first_name": "JEANNETTE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "786-501-0206",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Revamp Health Medspa",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Yelena Yvette Revere
• Gerardin Josefina Reverol Gonzalez, RBT-19-77418
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• Vivian Revilla Rodriguez, FNP
• Diego Revilla

• Registered Nurse in Miami, FL
• Providers in Miami, FL by specialty
• Registered Nurse in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.