Revive Clinic and Spa

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

REVIVE CLINIC AND SPA

Doing business as

Revive Dermatology Clinic and Spa

Practice address

1850 SW Plaza Shops LN Ste a
Ankeny, IA 50023-7168

Phone

(515) 965-5677

NPI assigned

Oct 25, 2019

Last updated

Aug 14, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Stefanie Gatica, DNP, FNP-CNPI 1093732828

Title

Owner

Phone

(515) 965-5677

Specialties & licenses 1

Addresses

Other names 1

• Revive Dermatology Clinic and Spa Doing business as

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Stefanie Gatica, ARNP

  • Family Nurse Practitioner
  • Ankeny, IA
  • NPI 1093732828
  Medicare reassignment NPD Authorized official
• Elizabeth Jordan Hamer, P.A.-C

  • Medical Physician Assistant
  • West Des Moines, IA
  • NPI 1770093106
  Medicare reassignment
• Darya Ann Hansen, ARNP

  • Nurse Practitioner
  • Ankeny, IA
  • NPI 1710552112
  NPD

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

{
    "created_epoch": "1571961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723593600000",
    "number": "1205479888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1850 SW PLAZA SHOPS LN STE A",
            "city": "ANKENY",
            "state": "IA",
            "postal_code": "500237168",
            "telephone_number": "515-965-5677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 SW PLAZA SHOPS LN STE A",
            "city": "ANKENY",
            "state": "IA",
            "postal_code": "500237168",
            "telephone_number": "515-965-5677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE CLINIC AND SPA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-25",
        "last_updated": "2024-08-14",
        "certification_date": "2024-08-14",
        "status": "A",
        "authorized_official_last_name": "GATICA",
        "authorized_official_first_name": "STEFANIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "515-965-5677",
        "authorized_official_credential": "DNP, FNP-C"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Revive Dermatology Clinic and Spa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Renze Chiropractic Clinic, P.C.
• Brett James Renze, D.C.
• Christopher Michael Renze, D.C., D.I.B.C.N.
• Restorative Therapy LLC
• Revitalize Wellness Center
• Revive Therapy Services, LLC
• Eric Reynolds, MD
• Abby Rae Rezansoff
• Rachel Rhamy, DPT
• Deanna Rice, LMSW

• Family Nurse Practitioner in Ankeny, IA
• Providers in Ankeny, IA by specialty
• Family Nurse Practitioner in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.